From the University of Pennsylvania School of Nursing, Center for Health Outcomes and Policy Research.
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
J Patient Saf. 2021 Dec 1;17(8):e1546-e1552. doi: 10.1097/PTS.0000000000000559.
Eighteen years ago, the Institute of Medicine estimated that medical errors in hospital were a major cause of mortality. Since that time, reducing patient harm and improving the culture of patient safety have been national health care priorities. The study objectives were to describe the current state of patient safety in pediatric acute care settings and to assess whether modifiable features of organizations are associated with better safety culture.
An observational cross-sectional study used 2015-2016 survey data on 177 hospitals in four U.S. states, including pediatric care in general hospitals and freestanding children's hospitals. Pediatric registered nurses providing direct patient care assessed hospital safety and the clinical work environment. Safety was measured by items from the Agency for Healthcare Research and Quality's Culture of Patient Safety survey. Hospital clinical work environment was measured by the National Quality Forum-endorsed Practice Environment Scale.
A total of 1875 pediatric nurses provided an assessment of safety in their hospitals. Sixty percent of pediatric nurses gave their hospitals less than an excellent grade on patient safety; significant variation across hospitals was observed. In the average hospital, 46% of nurses report that mistakes are held against them and 28% do not feel safe questioning authority regarding unsafe practices. Hospitals with better clinical work environments received better patient safety grades.
The culture of patient safety varies across U.S. hospital pediatric settings. In better clinical work environments, nurses report more positive safety culture and higher safety grades.
18 年前，美国医学研究所估计，医院中的医疗失误是导致患者死亡的主要原因之一。自那时以来，减少患者伤害和改善患者安全文化一直是国家医疗保健的重点。本研究旨在描述儿科急症环境中的患者安全现状，并评估组织中可改变的特征是否与更好的安全文化相关。
本研究采用 2015-2016 年美国四个州的 177 家医院的观察性横断面调查数据，包括综合医院和儿童医院的儿科护理。直接为患者提供护理的儿科注册护士评估了医院的安全性和临床工作环境。安全性通过医疗保健研究与质量局的患者安全文化调查中的项目进行衡量。医院临床工作环境通过国家质量论坛认可的实践环境量表进行衡量。
共有 1875 名儿科护士对其所在医院的安全性进行了评估。60%的儿科护士对其所在医院的患者安全给予了低于优秀的评分；医院之间存在显著差异。在平均医院中，有 46%的护士报告说他们的错误受到追究，有 28%的护士在质疑不安全做法的权威时感到不安全。临床工作环境较好的医院获得了更高的患者安全评分。
美国医院儿科环境中的患者安全文化存在差异。在临床工作环境较好的医院中，护士报告的安全文化更为积极，安全评分也更高。
