Department of Pediatric Surgery, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Pediatr Crit Care Med. 2011 Nov;12(6):e310-6. doi: 10.1097/PCC.0b013e318220afca.
Nowadays, the belief is widespread that a safety culture is crucial to achieving patient safety, yet there has been virtually no analysis of the safety culture in pediatric hospital settings so far. Our aim was to measure the safety climate in our unit, compare it with benchmarking data, and identify potential deficiencies.
Prospective longitudinal survey study at two points in time.
Pediatric surgical intensive care unit at a Dutch university hospital.
All unit personnel.
To measure the safety climate, the Safety Attitudes Questionnaire was administered to physicians, nurses, nursing assistants, pharmacists, technicians, and ward clerks in both May 2006 and May 2007. This questionnaire assesses caregiver attitudes through use of the six following scales: teamwork climate, job satisfaction, perceptions of management, safety climate, working conditions, and stress recognition. Earlier research showed that the Safety Attitudes Questionnaire has good psychometric properties and produced benchmarking data that can be used to evaluate strengths and weaknesses in a given clinical unit against peers.
The response rates for the Safety Attitudes Questionnaire were 85% (May 2006) and 74% (May 2007). There were mixed findings regarding the difference between physicians and nurses: on three scales (i.e., teamwork climate, safety climate, and stress recognition), physicians scored better than nurses at both points in time. On another two scales (i.e., perceptions of management and working conditions), nurses consistently had higher mean scale scores. Probably due to the small number of physicians, only some of these differences between physicians and nurses reached the level of statistical significance. Compared to benchmarking data, scores on perceptions of management were higher than expected (p < .01), whereas scores on stress recognition were low (p < .001). The scores on the other scales were somewhat above (job satisfaction), close to (teamwork climate, safety climate), or somewhat below (working conditions) what was expected on the basis of benchmarking data, but no persistent significant differences were observed on these scales.
Although on most domains the safety culture in our unit was good when compared to benchmark data, there is still room for improvement. This requires us to continue working on interventions intended to improve the safety culture, including crew resource management training, safety briefings, and senior executive walk rounds. More research is needed into the impact of creating a safety culture on patient outcomes.
如今，人们普遍认为安全文化对于实现患者安全至关重要，但迄今为止，几乎没有对儿科医院环境中的安全文化进行分析。我们的目的是测量我们单位的安全氛围，将其与基准数据进行比较，并确定潜在的缺陷。
在两个时间点进行前瞻性纵向调查研究。
荷兰一所大学医院的儿科外科重症监护病房。
所有单位人员。
为了测量安全氛围，在 2006 年 5 月和 2007 年 5 月两次向医生、护士、护理助理、药剂师、技术人员和病房职员发放了安全态度问卷。该问卷通过使用以下六个量表评估护理人员的态度：团队合作氛围、工作满意度、管理层看法、安全氛围、工作条件和压力识别。早期研究表明，安全态度问卷具有良好的心理测量学特性，并产生了基准数据，可用于根据同行评估特定临床单位的优势和劣势。
安全态度问卷的回复率分别为 85%（2006 年 5 月）和 74%（2007 年 5 月）。医生和护士之间的差异存在混合结果：在三个量表上（即团队合作氛围、安全氛围和压力识别），医生在两个时间点的得分均优于护士。在另外两个量表上（即管理层看法和工作条件），护士的平均量表得分始终较高。可能由于医生人数较少，只有一些医生和护士之间的差异达到了统计学意义的水平。与基准数据相比，管理层看法的得分高于预期（p<.01），而压力识别的得分较低（p<.001）。其他量表的得分略高于（工作满意度）、接近（团队合作氛围、安全氛围）或略低于（工作条件）基于基准数据的预期，但在这些量表上没有观察到持续显著差异。
虽然与基准数据相比，我们单位的安全文化在大多数领域都很好，但仍有改进的空间。这需要我们继续努力实施旨在改善安全文化的干预措施，包括机组资源管理培训、安全简报和高级管理人员巡视。需要进一步研究创建安全文化对患者结局的影响。
