안과병동 전화문의 응대 매뉴얼 구축을 통한 간호사 및 환자의 만족도 증진

이현정,박승혜,Lee, Hyun Jung,Park, Seung Hye 한국의료질향상학회 2010 한국의료질향상학회지 Vol.16 No.1

문제: 퇴원 환자의 문의 전화가 많아지면서 병동 간호사는 이 문의에 응하는 일로 업무량 과다, 전화 상담에 대한 자신감 저하 및 부담 등을 느끼고 있었다. 부적절한 전화문의 관리는 환자와 간호사 모두에게 시간 소모 및 만족도 저하 등의 부정적인 경험을 남길 수 있다. 목적: 전화문의 응대 매뉴얼 구축 및 활용으로 병동 간호사 및 퇴원 환자의 만족도를 향상시키고자 한다. 의료기관: 서울시 종로구에 소재한 대학병원. 질 향상 활동: 표준화된 전화문의 응대 매뉴얼을 개발하였다. 또한 간호사의 업무 효율성 및 지식 향상을 위해 간호사 대상 매뉴얼을 교육하여 실무에서 활용하기 쉽도록 하였다. 개선효과: 표준화된 전화문의 응대 매뉴얼을 안과 병동 간호사와 전보자 및 신규 간호사 교육에 활용할 수 있었다. 간호사의 전화문의 응대 관련 직무 만족도가 향상되었다. 환자 역시 표준화된 매뉴얼에 따라 일치되고 일관성 있는 정확한 정보를 제공받게 되어 환자의 만족도와 이해도가 증가할 것이다.

의료의 질 향상을 위한 환자중심 건강결과 측정의 국제 동향과 국내 시사점 - OECD PaRIS를 중심으로

최지숙,박영신,김지애,박춘선,Choi, Ji-Suk,Park, Young-Shin,Kim, Jee-Ae,Park, Choon-Seon 한국의료질향상학회 2019 한국의료질향상학회지 Vol.25 No.1

Purpose: The purpose of this paper is to derive implication on the adoption of PROMs (Patient-Reported Outcome Measures) to improve quality of care in South Korea. With this purpose, the paper examines the status of PROMs in South Korea and other countries including OECD's PaRIS (Patient Reported Indicators Survey) initiative, and reviews policy cases that have adopted PROMs to improve performance of healthcare system. Methods: We conducted literature review on OECD reports on PaRIS, peer-reviewed journals, and information from the websites of relevant institutions such as ICHOM, NQF and OECD. Results: To identify healthcare services of best values and support patient-centered health system, OECD has initiated PaRIS which develops, collects and analyzes patient-reported indicators for cross-countries comparison. PaRIS is implemented on two work streams: 1) collect, validate and standardize PROMs in the areas where patient-reported indicators already exist such as breast cancers, hip and knee replacement, and mental conditions, 2) develop a new international survey on multiple chronic conditions. Countries like England, U.S., Sweden and Netherlands use PROMs for measuring performance of hospitals and performance evaluation at the national level, and provide the financial incentives for reporting PROMs. Conclusions: The use of PROMs can support the current policy agenda that is the patient-centered healthcare system which has been emphasized to reinforce the primary and the community-based care. For the use of PROMs, it is recommended to actively participate in PaRIS initiative by OECD, select appropriate instruments for PROMs, and continue on standardization of them. This will assure patients' involvement in improving health system performance, systemize information generated in the process of adopting PROMs, and develop a system to evaluate performance.

국외 환자대상의 환자안전 교육 사례

김윤숙,곽미정,김문숙,김현아,김효선,천자혜,황지인,Kim, Yoon-Sook,Kwak, Mi-Jeong,Kim, Moon-Sook,Kim, Hyun-Ah,Kim, Hyuo-Sun,Chun, Ja-Hae,Hwang, Jee-In 한국의료질향상학회 2019 한국의료질향상학회지 Vol.25 No.1

Purpose: The purpose of this study was to share program and/or resource on patient safety education for patients and families conducted overseas agency. This study will help the patient safety officer establish and implement an educational plan for patients and families. Methods: We searched the Internet for patient safety related organizations. We chose an institution that provided education for patients and families. Results: Most of the program and/or resource was about patient and family involvement; Taking Care of Myself, My Questions for This Visit, Patient Prep Card, 20 Tips to Help Prevent Medical Errors, Ask Me 3(R), Health and Safety Passport, My Medication log etc. Conclusions: It is necessary to distribute educational materials for patients and families in the country through the results of this study. For patient safety, education and publicity are needed so that developed educational materials can be actively used.

낙상위험요인 평가 및 낙상예방활동 임상진료지침

천자혜,김현아,곽미정,김효선,박선경,김문숙,최애리,황지인,김윤숙,Chun, Ja-Hae,Kim, Hyun-Ah,Kwak, Mi-Jeong,Kim, Hyuo-Sun,Park, Sun-Kyung,Kim, Moon-Sook,Choi, Ae-Lee,Hwang, Jee-In,Kim, Yoon-Sook 한국의료질향상학회 2018 한국의료질향상학회지 Vol.24 No.2

Purpose: Falls are one of the most frequent health events in medical institutions, however, they can be predicted and prevented. The Quality Improvement Nurse Society clinical practice guideline Steering Committee developed the Clinical Practice Guideline for the assessment and prevention of falls in adult people. The purpose of this study was to assess the risk factors for falls in adults aged 19 years and older, to present an evidence for preventing falls, formulate a recommendations, and indicators for applying the recommendations. Methods: This clinical practice guideline was developed using a 23-step adaptation method according to the Handbook for clinical practice guideline developer (version 1.0) by National Evidence-based Healthcare Collaborating Agency. Evidence levels and recommendation ratings were established in accordance to SIGN 2011 (The Scottish Intercollegiate Guidelines Network). Results: The final 15 recommendations from four domains were derived from experts' advice; 1) assessment of risk factor for falls in adult 2) preventing falls and reducing the risks of falls or falls-related injury 3) management and reassessment after a person falls 4) leadership and culture. Conclusion: This clinical practice guideline can be used as a basis for evaluation and prevention of fall risk factors for adults, to formulate recommendations for fall risk assessment and fall prevention, and to present monitoring indicators for applying the recommendations.

간호대학생의 환자안전에 대한 지식, 간호전문직관과 환자안전관리활동의 관련성

김철규,유하민,김혜원,남아연,노희성,방다솔,신진의,이아현,이은경,전한용,정세림,정유정,Kim, Chul-Gyu,Yu, Ha-Min,Kim, Hye-Won,Nam, A-Yeon,Roh, Hee-Sung,Bang, Da-Sol,Sin, Jin-Ui,Lee, A-Hyun,Lee, Eun-Gyeong,Jeon, Han-yong,Jeong, Se-Lim,Jung, 한국의료질향상학회 2018 한국의료질향상학회지 Vol.24 No.2

Purpose: The objective of this study was to identify the relationship between knowledge of patient safety, nursing professionalism and patient safety management activities of nursing students with clinical practical experience. Methods: Self-administered questionnaires survey on knowledge of patient safety, nursing professionalism, and patient safety management activities were conducted for the $3^{rd}-year$ and $3^{th}-year$ nursing students. 139 questionnaires were distributed, of which, 131 were used for data analysis. Results: The scores of nursing students' knowledge of patient safety, nursing professionalism and patient safety management activities were $6.76{\pm}1.26$, $65.11{\pm}7.97$ and $67.99{\pm}7.26$, respectively. Knowledge of patient safety differed significantly according to the grade. Nursing professionalism had a difference with major satisfaction, clinical practical satisfaction, and experience of patient safety accident. Patient safety management activities were positively correlated (p<.01) with knowledge of patient safety and nursing professionalism. Patient safety management activities increased significantly with increase in the scores of knowledge of patient safety and nursing professionals. The factors that were related to patient safety management activities of nursing students were knowledge of patient safety and nursing professionalism. Knowledge of patient safety and nursing professionalism were selected as significant variables for explaining the patient safety management activities of nursing students, of which the coefficient of determination was 9.8%. Conclusion: To promote patient safety management activities of nursing students, training programs for patient safety management activities are required. Also, there is the need to increase the knowledge of patient safety and nursing professionalism of nursing students using various educational method.

비외상성 급성 복부 통증 환자에게 시행한 복부 전산화단층촬 영과 복부 단순 촬영의 적정성 비교

송정흡,염헌규,Song, Jung-Hup,Ryeom, Hun-Kyu 한국의료질향상학회 2018 한국의료질향상학회지 Vol.24 No.2

Purpose: To compare the Appropriateness of abdominal CT to abdominal radiography as an imaging modality in terms of the diagnostic value, medical costs and decision making times for patients presented to the emergency department with nontraumatic abdominal pain. Methods: This study used the records of 530 cases presented to the emergency department(ED) with nontraumatic abdominal pain from February to March 2012. Imaging modalities were categorized into abdominal radiography and CT (radiography first or CT first) or radiography alone or CT alone. The diagnostic value, total medical costs and effect on decision making time of the each imaging modalities were compared. Especially, in retrospective review, to evaluate the predictability of the abdominal radiography, alit was assumed that all the 530 cases performed that exam as initial imaging. Results: Among 530 cases, 255 cases underwent abdominal radiography only, 28 cases underwent abdominal CT only and the remnant 247 cases underwent abdominal CT with plain abdominal radiography. The diagnostic value was higher in the cases with abdominal CT (268/275, 97.5%) than in the cases with plain abdominal radiography (19/255, 7.5%).The number of cases predicted by abdominal radiography only as initial imaging were 39/530 (7.4%). In cases where the patients performed the abdominal CT as the first imaging modality thereby omitting the abdominal radiography, the total diagnostic imaging fee was lower than in cases with plain abdominal radiography first followed by the abdominal CT (277,140 vs. 284,226(mean, Korean Won)). Although diagnostic value of the plain abdominal radiography as first imaging modality was lower than the abdominal CT, Decision making time, average duration of hospital stay was longer and the total medical costs was higher than abdominal CT. Conclusion: As an imaging modality in the ED for patients with acute nontraumatic abdominal pain, plain abdominal radiography is an avoidable procedure when viewed in terms of the diagnostic value and total medical costs and decision making times comparing with abdominal CT.

뇌졸중 환자를 돌보는 주 보호자의 교육 요구도와 돌봄부담과의 관계

김은경,유혜연,Kim, Un-Kyeung,Yu, Hye-Yon 한국의료질향상학회 2019 한국의료질향상학회지 Vol.25 No.1

Purpose: The aim of the present study was to identify the relationship between educational needs and the caregiving burden of primary caregivers with stroke patient. Methods: This cross-sectional and descriptive study was conducted in 2016 with 115 primary caregivers for stroke patients at a university hospital. The caregiving burden and educational needs were investigated using structured questionnaires via interviews. Data were analyzed with descriptive statistics, the t-test or ANOVA, and Pearson's correlation analysis using IBM SPSS Statistics version 23.0. Results: The scores of caregiving burden and educational needs of primary caregiver with stroke patient were $77.65{\pm}1.66$ and $123.33{\pm}2.37$, respectively. The caregiving burden was associated with health status in primary caregivers' general characteristics. The caregiving burden and educational needs of primary caregivers have a significant correlation (r = .44, p <.001). Conclusions: Educational needs of primary caregivers with stroke patient are associated with their caregiving burden. Therefore, it is necessary to develop a primary caregiver centered intervention program considering educational needs to improve their caregiving burden. Also, to promote quality of nursing, there is the need to increase the educating competency of nurse and nursing professionalism of clinical nurse using various educational training program.

입원환자의 낙상 실태 및 위험요인 조사연구

윤수진,이천균,진인선,강중구,Yoon, Soo-Jin,Lee, Chun-Kyon,Jin, In-Sun,Kang, Jung-Gu 한국의료질향상학회 2018 한국의료질향상학회지 Vol.24 No.2

Purpose: The objective of this study was to report the incidence of falls in hospitals and analyze the risk factors for falls. Methods: This study used data on 1,216 patients who experienced falls from 2015 to 2017 during their hospitalization. The data was collected from the falls incident reports and patient' electronic medical record of hospital. Data were analyzed with descriptive statistics using Chi-square test, Fisher's exact test and multiple Poisson regression analysis with the SAS 9.4 Results: The incidence of falls was 1.38 per 1,000 patients days (2015), 1.81 per 1,000patients days (2016) and 1.99 per 1,000patients days (2017). The incidence of injury caused by falls (level III~V) was 0.05 per 1,000patients days (2015), 0.04 per 1,000patients days (2016) and 0.06 per 1,000patients days (2017). The largest number of falls occurred during night shift (42.5%), specifically in the patients' room (70.8%), and medical unit (66.0%). Average age of fallers was 69.1 years and 61.7% of them were older than 71 years. CCI and the patient's department have statistically significant differences in injury or injury levels from falls, but the integrated nursing care services had no significant difference in injury or injury levels from falls. Conclusion: The result of this study can be used as a reference for establishing a fall prevention strategy for hospitalized patients by presenting index values such as the fall rate.

의료기관 인증제도에 대한 인증 의료기관과 조사위원의 인식 비교

김경숙,이선희,Kim, Kyung-Sook,Lee, Sun-Hee 한국의료질향상학회 2016 한국의료질향상학회지 Vol.22 No.1

Objectives: Healthcare Accreditation Program in Korea started in 2011. The aim of this study is to contribute to the development of the Healthcare Accreditation Program in Korea by comparing the perception of the Healthcare Accreditation Program for the accredited hospitals and the surveyors. Methods: This study was performed targeting 77 accredited acute care hospitals and 245 surveyors who have surveyed acute care hospitals from 2010 to February 2014. They responded to our questionnaire via a survey website, and we analyzed the results. Results: We found that the hospitals rated the professionalism of surveyors more positively than surveyors. While average score of the hospitals was higher for 'The understanding of the accreditation standards and survey methods was correct' than that of the surveyors (p<0.01), average score of the surveyors was higher for 'Mediation and collaboration between surveyors were smooth' than that of the hospitals (p<0.05). And we found that the surveyors rated the Accreditation Program more positively than hospitals. While average score of the hospitals was higher for 'Surveyors have the professionalism' than that of the surveyors (p<0.05), average score of the surveyors was higher for 'It is easy to understand the accreditation standards and evaluation items' than that of the hospitals (p<0.01). Conclusion: In order to development of the accreditation program, it is necessary to strengthen the professionalism of surveyors and improve the acceptability of the accreditation program.

미국, 캐나다, 영국의 재입원율 활용 현황

이상아,주영준,신재용,박은철,이후연,Lee, Sang-Ah,Ju, Yeong-Jun,Shin, Jae-Yong,Park, Eun-Cheol,Lee, Hoo-Yeon 한국의료질향상학회 2016 한국의료질향상학회지 Vol.22 No.1

Readmission which reflects capacity to manage patients and general level of medical services has been known for one of the causes of medical expenditure due to inefficient service. Compared to disease-specific readmission, hospital wide readmission (HWR) is relatively easy to understand, and has merit to get over limitation of collateral medical services assessment; therefore, a growing interest in development and usage of readmission indicator as quality of care indicator focusing on all-disease is detected. In this study, we investigate current state of risk standardized readmission rate indicator used in the United States, the United Kingdom, and Canada, and examine the considerations when using readmission rate as quality indicator in Korea. Differences in risk-adjustment methods were showed among countries. The United States do not control race not to hide socio-demographic factors on readmission. Canada shows differentiation compared to other countries about reflecting community factors. All three-countries utilize readmission rate as monitoring quality of care rather than incentives or penalty due to the fact that readmission rate could not represent the whole quality of hospital and has a limitation at controlling socio-economic factors. Therefore, for usage readmission rate as quality indicator in Korea, preparing readmission classification standard for Korean medical environment and additional methods for acquiring information by using discharge summary is need. Moreover, continued discussion with clinical specialists is needed for obtain clinical reliability and validity.