Year 1 medical undergraduates’ knowledge of and attitudes to medical error

Context To improve patient safety, medical students should be taught about human error and the factors influencing adverse events. The optimal evaluation of new curricula for patient safety requires tools for baseline measurement of medical students’ attitudes and knowledge. Objectives The aim of the study was to design and evaluate a questionnaire for measuring the attitudes of Year 1 medical students to patient safety and medical error. Methods A questionnaire entitled ‘Medical Students’ Patient Safety Questionnaire (Year 1)’ was designed to assess Year 1 medical students’ attitudes and anticipated behaviours relating to medical error and patient safety. This was administered to two cohorts of Year 1 medical students in a UK medical school during 2008 (n = 296) and the data subjected to psychometric analyses. Results Medical students’ attitudes to good patient safety practices were generally positive, but the students had little knowledge of how to report errors and were unsure about what to do if a colleague made an error or if a patient indicated that an error had been made. On the five scales of the questionnaire, Cronbach’s α values ranged from 0.59 (Attitudes to patient safety scale) to 0.88 (Knowledge of error and patient safety scale) and three scales showed internal consistencies below the recommended value of 0.70. Exploratory factor analysis showed that the five factors explain 51.7% of variance. Conclusions With some minor item trimming and re‐allocation, the Medical Students’ Patient Safety Questionnaire (Year 1) can function as an instrument with which to assess the attitudes of new medical students to patient safety and medical error. To assess the suitability of the instrument beyond the UK would require additional work.     

某医科大学不同专业学生营养知识态度和饮食行为调查

目的了解某医科大学不同专业学生的营养知识、态度和饮食行为,为有针对性地开展营养教育提供科学依据。方法采用自行设计的营养知识、态度、饮食行为调查问卷,随机抽取某医科大学不同专业学生682人。结果医学相关专业大学生在营养知识最高达86%、态度最高达86%和饮食行为53.25%,均比非医学相关专业高。所有大学生对营养知识掌握均较好、营养态度积极程度较高,但是在饮食行为方面较差。结论医科大学生营养知识普遍缺乏,应加强营养教育,提高营养知识和态度,促进其改变不良的饮食行为,促进健康。     

The ethical leadership challenge: creating a culture of patient- and family-centered care in the hospital setting

The growing number of medical errors and resulting preventable deaths in hospitals presents an ethical dilemma that must be addressed by health care leaders and managers. These medical errors and deaths raise questions about safety and quality issues resulting in rising public mistrust and patient dissatisfaction. Many of these medical errors and deaths could have been avoided by including the patient and family in the care. The ethical challenge for leadership is creating a culture of patient- and family-centered care as a means to improve quality, safety, patient satisfaction, and public trust. This article addresses ways to improve safety, quality, patient satisfaction, and cost and thereby reduce medical errors and deaths by implementing a patient- and family-centered care culture. The first critical step for improvement is for hospital leaders and managers to answer the ethical call to create a culture centered on patient- and family-centered care in the hospital setting.     

The challenges to transparency in reporting medical errors

In an ideal health care environment, physicians and health care organizations would acknowledge and factually report all medical errors and "near misses" in an effort to improve future patient safety by better identifying systemic safety lapses. Truth must permeate the health care system to achieve the goal of transparency. The Institute of Medicine has estimated that 44,000 to 98,000 patients die each year as a result of medical errors. Improving the reporting of medical errors and near misses is essential for better prevention of medical errors and thus increasing patient safety. Higher rates of reporting can permit identification of the root causes of errors and create improved processes that can significantly reduce errors in future patient care. Multiple barriers exist with respect to reporting medical errors, despite the ethical and various professional, regulatory, and legislative expectations and requirements generating this obligation. As long as physicians perceive that they are at risk for sanctions, malpractice claims, and unpredictable compensation of injured patients as determined by the United States' tort law system, legislative or regulative reform is unlikely to affect the underreporting of medical errors, and patient safety cannot benefit from the lessons derived from past medical errors and near misses. A new infrastructure for creating patient safety systems, as identified in the Patient Safety and Quality Improvement Act of 2005 is needed. A patient compensation system guided by an administrative health court that includes some form of no-fault insurance must be studied to identify benefits and risks. Most urgent is the development of a reporting system for medical errors and near misses that is transparent and effectively recognizes the legitimate concerns of physicians and health care providers and improves patient safety.     

Measures to enhance patient safety. Importance of efficiency evaluation

Over the last 10?years, there has been increasing awareness of medical errors and harm to patients in healthcare. There is now widespread acceptance of the problem of medical harm and a determination to tackle major patient safety problems. Safety is defined as freedom from accidental injury. Thus, clinical risk management has been increasingly requested by professionals and their professional organizations to make healthcare safer. Clinical risk management is one of a number of organizational systems or processes aimed to improve the quality of healthcare, but one which is primarily concerned with creating and maintaining safe systems of care. A definition of this form ?C identifying, analyzing, and controlling risks ?C fits more comfortably with the culture and mission of healthcare organizations and is more likely to achieve the support and involvement of clinical professionals because it better reflects their purpose and values. Patient safety needs to become embedded in the culture of healthcare, not just in the sense of individual high standards, but a widespread acceptance of understanding of risk and safety and the need of everyone to actively promote patient safety. Measures taken to enhance patient safety encompass a wide range of activities with regard to the errors in the process of medication, to surgical errors and surgical outcome (??safer surgery saves lives??), and to hospitalism and hospital-acquired infections taking into consideration adherence to hand hygiene. An evaluation of the added value to patient safety, when processes are systematically changed and the patients become involved in making healthcare safer, is needed.     

Perceptions of and attitudes towards medical errors among medical trainees

OBJECTIVES: The purpose of this study was to develop a better understanding of how medical trainees define medical errors and what factors influence medical trainees' perceptions of medical errors. METHODS: We surveyed 423 medical students and house staff at an urban academic medical centre to learn about how they defined medical errors, their experiences with medical errors, their beliefs about when a patient should be informed of an error, and their attitudes towards medical errors with differing severity of outcomes. RESULTS: Trainees stated that an event could be considered an error regardless of outcome, negligence, intention or consent. Definitions did not vary according to gender or level of training. Trainees had increasing feelings of guilt and fear as the outcomes related to errors worsened. Respondents were more likely to feel guilty and angry at themselves, and be afraid of accusations of malpractice, losing their licence, damaging their reputation, or losing confidence when errors were made while working individually versus in a team setting. Female trainees were more likely than male trainees to feel guilty and angry at themselves, and were afraid of losing confidence if they made an error. CONCLUSIONS: Trainees' perceptions and attitudes towards errors vary depending on whether they are in their clinical years, the severity of outcome, and whether the error is attributable to an individual or a team. These factors will have to be explored in greater depth if we are adequately to prepare young doctors for the errors they will inevitably make.     

石河子大学医学生食品安全知识、态度及行为调查

目的对石河子大学医学院大学生食品安全知识、态度及行为情况进行调查,并分析其影响因素,为大学生食品安全健康教育提供依据。方法随机抽取医学院6个专业925名大学生进行食品安全知识、态度及行为问卷调查。结果医学生食品安全知识平均得分（5.77±1.87）分,不同年级学生得分不全相同,高年级组得分高于低年级组,差异有统计学意义（χ^2=14.588,P=0.006）;女生得分（5.88±1.74）高于男生（5.57±2.07）,差异有统计学意义（Z=-2.576,P=0.007）;汉族得分（5.95±1.82）高于少数民族（5.04±1.90）,差异有统计学意义（Z=-5.603,P=0.000）;学过食品相关课程的学生得分（5.99±1.88）高于未学过的学生（5.64±1.85）,差异有统计学意义（Z=-2.764,P=0.006）;电视、网络是医学生获取食品安全信息和知识的主要途径。结论高校应加强对大学生的食品安全教育,使他们获得更多的食品安全知识,改变不良的行为习惯。     

新建综合性医院医护人员患者安全文化研究

目的了解某新建综合性医院医护人员患者安全文化现状,寻找薄弱环节和潜在隐患,为患者安全文化水平持续改进与不断提升提供参考依据。方法采用美国医疗服务质量和研究组织通行的患者安全问卷调查法,计算正性回答率,获得该医院患者安全文化数据,和AHRQ同类医院正性反应率进行比较。结果该医院部门/区域安全等级评分正性反应率为75.5%。差错的反馈和交流、组织文化-不断改善、科室内部团队合作3个维度为患者安全优势领域。对差错的非惩罚性处理、人员配备、不良事件上报频率、科室间团队合作4个维度,为患者安全待改进领域;正性反应率最低的维度及与AHRQ差值最大的维度差错的非惩罚性处理、不良事件报告频率,提示为制约新建医院患者安全文化建设的关键环节及影响因素。结论建立公正文化,可促进不良事件上报,提升患者安全水平。     

Patient safety: solutions in managed care organizations?

Despite the growing acknowledgment of the necessity for patient safety initiatives to address medical errors, the role of managed care organizations (MCOs) in these programs has only recently been challenged. Managed care quality improvement programs have mainly focused upon pay-for-performance initiatives, largely ignoring specific patient safety efforts. To effectively reduce medical errors, MCOs must leverage their unique positions to influence and educate both providers and consumers. This article describes MCOs' self-implemented barriers to quality improvement, and early initiatives by MCOs to encourage safe practices, including pay-for-performance. An approach for MCOs to facilitate progress and inspire a culture of patient safety is discussed. Avenues for strengthening the organizational and technological infrastructure of the health care system from a managed care perspective are examined, and strategies for implementing best practices within the constraints of managed care are explored. System-wide solutions that address the critical areas of culture, infrastructure, and best practices are necessary to continue to make significant strides in reducing medical errors and prioritizing patient safety.     

某院医务人员患者安全文化认知情况调查与分析

目的了解医务人员对患者安全文化认知及建设的现状,为患者安全管理及研究提供依据。方法2012年1月随机抽取上海市中医医院257名医务人员,应用患者安全文化现状评价调查问卷进行调查,用以了解临床医务人员的患者安全文化态度及其机构相关的患者安全文化。结果不同专业医务工作者在团队精神、安全措施、医院管理及交接班程序之间存在差异,提示具有重要的研究意义。其中药剂人员（4．5±0．6）以及护理部工作人员（4．5±0．6）的总分认知度最高,医技人员总分认知度最低（4．4±0．5）。不同职务的医务人员认同的患者安全文化,副／高级（4．8±0．4）〉中级（4．6±0．6）〉初级（4．4±0．5）。患者安全文化待改进领域：“人员配置”“工作量”“如果发生医疗安全（不良）事件,医院更加重视帮助与教育”反应率〈50％,是医务人员共同认为有待改进地方的前几位。结论某院有积极的患者安全文化,但仍需完善现有的不良事件报告系统及加强高风险科室的安全管理与人员教育培训。     

Career Success and Life Satisfaction for Female and Male Healthcare Managers

Medical errors cause up to 98,000 people to die annually in the United States. They are the fifth leading cause of death and cost the United States $29 billion annually (Kohn 1999). Medical errors fall into 4 main categories: diagnostic, treatment, preventative, and other. A review of literature reveals several proposed solutions to the medical error problem. One solution is to change the system for reporting medical errors. This would allow for the tracking of errors and provide information on potential problematic areas. A National Center for Patient Safety is proposed, which would set national goals towards medical errors. Another solution is the setting of performance standards among individual entities of healthcare delivery, such as hospitals and clinics. Another solution involves implementing a culture of safety among healthcare organizations. This would put the responsibility of safety on everyone in the organization. A change in education is yet another proposed solution. Informing medical students about errors and how to deal with them will help future physicians prevent such errors. The final solution involves improvements in information technology. These improvements will help track errors, but also will prevent errors. A combination of these solutions will change the focus of the healthcare industry toward safety and will eventually lead to billions in savings, but more importantly, the saving of lives.     

员工对患者安全文化认知的现状调研

目的 了解某医院患者安全文化现状,为持续改善医疗质量提供依据。方法 对全院员工发放中文版医院患者安全文化调查表（HSOPSC）,计算量表各维度及各条目的积极反应率。结果 共1 208名员工参与调查,组织的学习与持续改进、科室内团队合作、对医院安全的总体评价、管理者在促进患者安全方面的意愿和行动、管理者对患者安全的支持、交接班和转科等维度积极反应率均大于75%,为优势区域;人员配置、对错误的非惩罚性反应、沟通开放程度、不良事件报告频率等维度积极反应率均小于50%,为待改进区域。不同职称、学历、下班延误时间、年龄、岗位、与患者直接接触等因素对医院患者安全文化总分有显著影响。结论 该院员工对患者安全文化认知现状较好,但在人员配置等方面需继续改进。     

An organizational approach to understanding patient safety and medical errors

Progress in patient safety, or lack thereof, is a cause for great concern. In this article, we argue that the patient safety movement has failed to reach its goals of eradicating or, at least, significantly reducing errors because of an inappropriate focus on provider and patient-level factors with no real attention to the organizational factors that affect patient safety. We describe an organizational approach to patient safety using different organizational theory perspectives and make several propositions to push patient safety research and practice in a direction that is more likely to improve care processes and outcomes. From a Contingency Theory perspective, we suggest that health care organizations, in general, operate under a misfit between contingencies and structures. This misfit is mainly due to lack of flexibility, cost containment, and lack of regulations, thus explaining the high level of errors committed in these organizations. From an organizational culture perspective, we argue that health care organizations must change their assumptions, beliefs, values, and artifacts to change their culture from a culture of blame to a culture of safety and thus reduce medical errors. From an organizational learning perspective, we discuss how reporting, analyzing, and acting on error information can result in reduced errors in health care organizations.     

贵阳城区部分青春期女生营养知识与生长发育现况调查

目的了解贵阳市青春期女生营养知识、态度、行为和生长发育状况,为开展营养干预提供参考。方法对贵阳市627名青春期女生进行身高、体重测量及营养知识问卷调查。结果学生营养知识平均得分为2.82分,多数学生缺乏基本的营养知识,营养知识得分高组的生长发育状况有优于低组的趋势;大部分女生在饮食态度及行为上存在较多问题,仅18.3%的女生在选择食物时考虑食物的营养,20.4%的女生获得有关知识的途径是学校教育。结论加强营养教育,给予学生系统的正确的营养知识和观念,是改善生长发育的重要措施。     

陕西省6所三级医院患者安全文化现状及影响因素研究

目的了解陕西省三级医院患者安全文化现状,分析影响因素,为推动医院文化建设、实现医院安全管理提供参考。方法于2018年7月-9月向陕西省6所三级医院的医务人员发放问卷进行横断面调查,运用SPSS 22.0软件对所获数据进行统计分析。结果调查医务人员共计1 065名。患者安全文化总体评分为（3.74±0.41）分,83.00%的医务人员认为患者安全等级“非常好”或“很好”。患者安全等级的影响因素有性别、最高学历、用工形式、参与6S培训（P＜0.05）。对错误的反馈与交流、医院交接班与转科程序、医院管理支持、对患者安全的全面理解和医院各部门之间的协作等维度与患者安全等级呈正相关（P＜0.05）。结论参与调查的医院患者安全文化总体水平中等偏上。医院应积极使用质量管理工具,针对不同人员采用个性化措施,加大管理支持力度,重视差错事件的持续改进,以不断提升患者安全管理水平。     

患者安全目标:加强医务人员之间有效沟通的管理策略

医务人员之间有效沟通是医疗安全管理的基础，对于避免医疗差错起着至关重要的作用。文章从个人、环境、团队方面分析了影响医务人员之间有效沟通的影响因素，阐述了通过使用规范的核查表、营造积极沟通的文化氛围、构建温馨的工作环境、提供跨团队的照护计划、加强培训等方面的做法，并提出相关思考和建议，为提升患者安全，加强医院安全管理提供参考。     

高校学生传染病防治知识态度行为调查

目的分析和调查高校学生传染病防治知识态度行为。方法通过随机抽样的方法,对该市某高校的大一、大二、大三的学生进行传染病防治知识、态度与行为问卷调查,一共500人参与该次调查,非医学专业学生共250名,医学专业学生共250名,分析高校大学生对传染病知识的掌握情况、传染病防治态度和行为。比较非医学专业学生和医学专业学生对传染病知识的掌握情况、传染病防治态度和行为。结果与非医学专业学生对比,医学专业学生对传染病知识的掌握正确率明显更高,差异有统计学意义(P<0.05)。与非医学专业学生对比,医学专业学生对传染病防治态度和行为的掌握正确率明显更高,差异有统计学意义(P<0.05)。结论大学生是传染病的易感人群,也是防治传染病的主要力量,必须加强对高校大学生正确防治传染病的知识,增强其防治传染病的意识,从而纠正其不合理的卫生习惯及行为。     

病人安全文化影响因素作用机制的路径分析

目的 筛选病人安全文化的影响因素并探索各因素对病人安全文化系统的影响机制,为更好地提高患者安全提供参考依据.方法 采用中文修订版医院病人安全文化调查表(C-HSOPSC),通过随机抽样的方法,对黑龙江省291名医院管理层人员进行现场调查,运用线性回归模型和Kendall相关系数筛选病人安全文化影响因素,利用路径分析方法探索其影响路径并建立路径模型.结果 路径分析结果表明,医院管理者的支持对病人安全文化直接影响最大,科室内团队合作也是重要的影响因素,但需要通过管理者支持才能对病人安全文化起到最大的间接作用.结论 病人安全涵盖多重维度视角,医院管理者应结合院领导的支持、科室内团队合作、非惩罚性文化、医务人员的沟通与交流等重要因素的影响路径采取相应干预措施.     

Preventive care attitudes of medical students

Presently developing attitudes of future physicians towards preventive medicine will likely provide either a major impetus for or barriers to the inclusion of preventive medicine content in medical school curricula and in other formats of physician education. In turn, attitudes about preventive care and its role in medical practice will continue to have a large influence on how much disease prevention and health promotion emphasis physicians provide in their practices. Consequently, it becomes important to study how medical students' attitudes evolve during the process of medical education. Furthermore, to the extent that we can better understand how desired attitudes can be developed and nurtured, the practice of preventive medicine may become more purposeful. Beginning and third-year medical students were surveyed with a 100-item questionnaire designed to assess their attitudes regarding: the relative importance of 20 specific preventive services to the practice of medicine and the adequacy of preclinical coursework for preparing them to offer preventive care in medical practice. The confidence of third year students' in the ability of primary care physicians to provide these specific services was also assessed. Preventive care service areas about which third-year students expressed high confidence in the ability of physicians to provide were: immunizations, health screening physicals, blood pressure control, cancer detection education, family planning, health counseling/education, and sexually transmitted disease prevention. Services that students had low confidence in the ability of physicians to provide were: smoking cessation, nutrition counseling/education and weight reduction.(ABSTRACT TRUNCATED AT 250 WORDS)