Bovis Joanna Lucy, Edwin John Pradeep, Bano Chris Patrick, Tyraskis Athanasios, Baskaran Dinnish, Karuppaiah Karthik
King's College Hospital, London, UK.
Future Healthc J. 2018 Jun;5(2):117-120. doi: 10.7861/futurehosp.5-2-117.
Our study assessed barriers to reporting adverse incidents (AIs). Adverse incident reporting (AIR), although it is a pillar of risk management, has a wide variation in staff perception and usage. A questionnaire was used in five NHS hospitals to assess 267 members of multidisciplinary team (MDT) staff usage of AIR. Thirty-three percent of staff had never reported an adverse incident (AI). Fourty-one percent of staff had missed opportunities to report AIs due to a poor response to previous reports. The group who missed opportunities had a significantly higher proportion of not having received feedback to their previous AI (p=0.03). In the group who had received training, 79% had submitted an AI. This was significantly higher than the group who had not received training (63%, p=0.02). Our study revealed that training and feedback following AIR are two major factors that could improve confidence in and use of AI reporting.
我们的研究评估了不良事件报告的障碍。不良事件报告（AIR）虽是风险管理的一项支柱，但在员工认知和使用方面存在很大差异。我们在五家国民保健服务（NHS）医院使用问卷调查了267名多学科团队（MDT）工作人员对不良事件报告的使用情况。33%的工作人员从未报告过不良事件（AI）。41%的工作人员因对先前报告的反馈不佳而错过报告不良事件的机会。错过机会的群体中，未收到对其先前不良事件反馈的比例显著更高（p=0.03）。在接受过培训的群体中，79%的人提交过不良事件报告。这显著高于未接受过培训的群体（63%，p=0.02）。我们的研究表明，不良事件报告后的培训和反馈是可以提高对不良事件报告的信心及使用率的两个主要因素。
