Skrb za pacienta in varnost pri dajanju zdravil v zdravstveni negi

doktorska disertacija

Dominika Jakl (Avtor), Majda Pajnkihar (Mentor), Dušica Pahor (Član komisije za zagovor), Pavel Skok (Član komisije za zagovor), Dušica Pahor (Komentor)

Povzetek

Izhodišča: Poznavanje vzrokov za napake pri dajanju zdravil, ovir sporočanja ter ocene sporočanja je pomembno za zagotavljanje kakovostne in varne obravnave pacientov, takšnih raziskav pa v slovenskem okolju primanjkuje. Strokovnjaki ocenjujejo, da je za varnost pacientov med drugim potrebna tudi ustrezna kultura skrbi, vendar je zaenkrat še premalo raziskav, ki bi potrdili povezanost kulture skrbi s kazalniki kakovosti in varnostjo pacientov. Z doktorsko disertacijo smo želeli raziskati zaznavanje vzrokov za napake pri dajanju zdravil, ovir sporočanja in ocene sporočanja napak ter kulturo skrbi, izraženo kot zaznavanje skrbi posameznika pri lastnem delu, pri sodelavcih in nadrejenih, v delovnem okolju ter ugotoviti njihove povezave. Metode: Izvedli smo multicentrično presečno opazovalno raziskavo z uporabo zaporednega pojasnjevalnega načrta mešanih metod na populaciji zaposlenih v zdravstveni negi na internih in kirurških oddelkih v 11 slovenskih bolnišnicah. Podatke v okviru kvantitativnega dela smo zbrali s pomočjo petih psihometrično veljavnih in zanesljivih vprašalnikov. Zbrane podatke smo nato analizirali z uporabo deskriptivne in inferenčne statistike. V okviru kvalitativnega dela smo uporabili metodo utemeljene teorije, podatke pa zbrali s pomočjo vprašanj odprtega tipa v anketnem vprašalniku in delno strukturiranimi intervjuji. Rezultati: Ugotovili smo, da so vzroki za nastanek napak organizacijske in individualne narave. Anketiranci so komponente kadrovsko-delovni procesi, komunikacija z zdravniki in znanje ocenili z najvišjimi povprečnimi ocenami. Ugotovili smo pomanjkljivo sporočanje napak, saj so anketiranci ocenili, da se na njihovem oddelku sporoči manj kot 60 % vseh napak pri dajanju zdravil (p ≤ 0,001). Kar 37,6 % pa jih je ocenilo, da se vse vrste napak sporočijo v 0–20 %. Na pomanjkljivo sporočanje napak pri dajanju zdravil vpliva več dejavnikov na organizacijski in individualni ravni, kot največji oviri pa sta bili z najvišjimi povprečnimi ocenami ocenjeni komponenti odziv in strah. Rezultati so pokazali tudi, da je zaznavanje vzrokov za napake, ovir sporočanja, ocene sporočanja in kulture skrbi odvisno od določenih demografskih značilnosti posameznika, oddelkov in ustanov. Kultura skrbi je na srednji ravni, saj so anketiranci povprečno ocenili vse elemente kulture skrbi, povprečno so ocenili k osebi osredotočeno skrb v okolju, skrb pri svojem delu pa so ocenili bolje kot skrb pri nadrejenem in sodelavcih. Anketiranci, ki so bolje ocenili k osebi osredotočeno skrb v okolju, klimo varnosti, skrb pri lastnem delu in skrb pri nadrejenem, so ocenili, da se sporoči višji odstotek napak, in sicer 61–100 % vseh napak (p ≤ 0,05). Z rezultati kvalitativne raziskave smo dobili še bolj poglobljen vpogled v obravnavano problematiko. Razprava in zaključki: Kultura skrbi je osnova za zagotavljanje varnosti pri dajanju zdravil, vendar je slednja odvisna od številnih drugih, predvsem sistemskih dejavnikov. Za boljšo varnost pri dajanju zdravil potrebujemo sistemski pristop obravnave napak. Na oddelkih in predvsem na ravni ustanov potrebujemo neobtožujočo, nekaznovalno učno kulturo, v kateri bodo zaposleni brez strahu sporočali napake.

Ključne besede

sporočanje napak;bolnišnica;pacient;zdravila;

Podatki

Jezik:	Slovenski jezik
Leto izida:	2017
Tipologija:	2.08 - Doktorska disertacija
Organizacija:	UM MF - Medicinska fakulteta
Založnik:	D. Vrbnjak]
UDK:	616-035-085:615.014.2+614.212(043.3)
COBISS:	6155583
Št. ogledov:	3015
Št. prenosov:	980
Ocena:	0 (0 glasov)
Metapodatki:

Ostali podatki

Sekundarni jezik:	Angleški jezik
Sekundarni naslov:	Caring for patient and safety in medication administration in nursing
Sekundarni povzetek:	Background: Knowing the causes of medication errors, barriers of reporting and estimation of reported medication errors are important for ensuring patients’ quality and safety and there is a lack of such studies in Slovenia. Experts estimate, that among other factors caring culture is also needed for patient safety, however, there is a lack of research confirming the link between caring culture and quality indicators and patient safety. Therefore, we wanted to research perception of causes of errors in medication administration, barriers of reporting, estimation of reported errors and caring culture expressed as caring of care providers, co-workers, managers and in a working environment and determine their correlations. Methods: A multicentre cross-sectional observational study using mixed methods sequential explanatory design was conducted on a population of employees in nursing working on internal and surgical wards in eleven Slovenian hospitals. Data within quantitative strand were gathered using five psychometric valid and reliable questionnaires and then analysed using descriptive and inferential statistics. The grounded theory approach was used within qualitative strand. Data were gathered using open ended survey questions and semi-structured interviews. Results: Results showed there are organizational and individual causes of medication errors. Nurse staffing and work processes, physician communication and knowledge were assessed with highest average values. We found underreporting, as respondents assessed there are a less than 60% of occurred medication administration errors reported on their wards (p ≤ 0.001). 37.6% evaluated that all errors are reported in 0-20%. Underreporting is influenced by several factors at the organizational and individual level. Response and fear were found with highest average values. Results also showed that perception of medication administration error causes, reporting barriers and estimation of reported errors are dependent on certain demographic characteristics of individuals, wards and institutions. Caring culture is average, as respondents assessed all elements of caring culture with average mean values. Person-centred climate was assessed as the average, while caring of the provider was assessed better than caring of managers and co-workers. Respondents who assessed person-centred climate, safety climate, caring of provider and caring of manager with higher mean values perceived better medication error reporting, they perceived that 61-100% of all errors is reported (p ≤ 0,05). Results of a qualitative strand provided even more in-depth insight into the researched problem. Discussion and conclusions: Caring culture is the foundation for ensuring medication administration safety, but the latter is dependent on several other mainly organizational, system factors. A system approach is needed to manage medication administration safety. Non-punitive, non-blaming learning culture is needed on hospital wards and especially at the institutional level, so nurses can report errors without fear.
Sekundarne ključne besede:	Nursing care;Zdravstvena nega;Medication errors;Napake pri zdravljenju z zdravili;Patient safety;Varnost bolnikov;
URN:	URN:SI:UM:
Vrsta dela (COBISS):	Doktorska disertacija
Komentar na gradivo:	Univ. v Mariboru, Medicinska fak.
Strani:	XIII, 209, 55 str.
ID:	9608482