• 한국임상약학회지
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• 제32권2호
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• pp.116-124
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• 2022

Background: High-alert medications (HAMs) are medications that bear a heightened risk of causing significant patient harm if used in error. To facilitate safe use of HAMs, identifying specific HAM lists for clinical setting is necessary. We aimed to develop the national level HAM list for acute care setting. Methods: We used three-step process. First, we compiled the pre-existing lists referring HAMs. Second, we analyzed medication related incidents reported from national patient safety incident report data and adverse events indicating medication errors from the Korea Adverse Event Reporting System (KAERS). We also surveyed the assistant staffs to support patient safety tasks and pharmacist in charge of medication safety in acute care hospital. From findings from analysis and survey results we created additional candidate list of HAMs. Third, we derived the final list for HAMs in acute care settings through expert panel surveys. Results: From pre-existing HAM list, preliminary list consisting of 42 medication class/ingredients was derived. Eight assistant staff to support patient safety tasks and 39 pharmacists in charge of medication safety responded to the survey. Additional 44 medication were listed from national patient safety incident report data, KAERS data and common medications involved in prescribing errors and dispensing errors from survey data. A list of mandatory and optional HAMs consisting of 10 and 6 medication classes, respectively, was developed by consensus of the expert group. Conclusion: We developed national level HAM list for Korean acute care setting from pre-existing lists, analyzing medication error data, survey and expert panel consensus.

• 한국산학기술학회논문지
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• 제13권6호
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• pp.2607-2616
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• 2012

본 연구에서는 의료기관의 환자안전문화를 이해하고, 의사들의 환자안전문화에 대한 인식분석을 위한 기초자료로 활용하고자 시도하였다. G시에 소재한 상급종합병원 의사를 대상으로 2011년 8월 1일 부터 9월 5일까지 설문조사하여 194부를 최종분석 하였다. 연구결과는 첫째, 대상자와 병동 및 병원안전문화 간의 관계는 직원배치가 성별, 연령별, 병원 근무년수, 환자 접촉여부, 1주 근무시간에 따라 인식의 차이가 있으며, 조직학습과 병동내 팀워크는 1주 근무시간에 따라, 병동 안전문화 모든 하부영역은 진료과별로 유의하게 나타났다. 둘째, 대상자와 의료사고보고체계, 환자 안전도 평가 및 전반적 의식수준과의 관계에서는 사고에 대한 피드백과 의사소통, 사고빈도보고, 전반적 안전의식이 진료과별로 유의하였으며, 전반적 안전의식은 환자접촉과 1주 근무시간에 따라 유의한 결과를 나타냈다. 셋째, 병동 및 병원 안전문화 인식 하부영역과 전반적 인식, 환자안전도 평가는 모두 정의 상관관계가 있는 것으로 나타났다. 의료사고 보고체계와는 직속상관/관리자의 태도와 병원경영진의 태도를 제외한 모든 영역에서 정의 상관관계가 있는 것으로 나타났다. 넷째, 환자안전도 영향을 미치는 환자안전문화 하부영역은 조직학습, 의사소통의 개방성, 전반적 안전인식, 부서간의 협조체계, 피드백과 의사소통, 비처벌적 대응에서 유의한 결과를 나타냈다. 결론적으로, 의사들의 병동 및 병원 환자안전문화 수준을 높이고 의료사고보고체계를 충실하게 하기 위해서는 적절한 직원배치와 근무시간을 바탕으로 병동 내 조직적 학습을 통한 팀워크을 활성화 시키고, 부서간 팀원간의 개방적 의사소통과 사고에 대한 피드백을 제공하여 환자 안전에 대한 병원경영진의 적극적인 지원과 진료과별 협조체계 구축이 필요하다.

• Safety and Health at Work
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• 제1권2호
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• pp.134-139
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• 2010

Objectives: The lung cancer mortality in Korea has increased remarkably during the last 20 years, and has been the first leading cause of cancer-related deaths since 2000. The aim of the current study was to examine the time trends of occupational lung cancer and carcinogens exposure during the period 2006-2009 in South Korea, by assessing the proportion of occupational burden. Methods: We defined occupational lung cancer for surveillance, and developed a reporting protocol and reporting website for the surveillance of occupational lung cancer. The study patients were chosen from 9 participating university hospitals in the following 7 areas: Seoul, Incheon, Wonju, Daejeon, Daegu, Busan, and Gwangju. Results: The combined proportion of definite and probable occupational lung cancer among all lung cancers investigated in this study was 10.0%, 8.6%, 10.7%, and 15.8% in the years 2006 to 2009, respectively, with an average of 11.7% over the four-year study period. The main carcinogens were asbestos, crystalline silica, radon, polyaromatic hydrocarbons (PAHs), diesel exhaust particles, chromium, and nickel. Conclusion: We estimated that about 11.7% of the incident lung cancer was preventable. This reveals the potential to considerably reduce lung cancer by intervention in occupational fields.

• 간호행정학회지
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• 제20권4호
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• pp.353-361
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• 2014

Purpose: The aim of this study was to compare job satisfaction, quality of life (QOL), incident report rate and overtime hours for 12-hour shifts and for 8-hour shifts in a pediatric intensive care unit (PICU). Methods: A descriptive survey was conducted with a convenience sample of 36 staff nurses from a PICU in a regional hospital in Korea. Data were collected using self-administrated questionnaires regarding job satisfaction and QOL at 6 months before and after the beginning of 12-hour shifts. Incident report rate and overtime hours for both 12-hour and 8-hour shifts were compared. Comparisons were made using $x^2$-test, paired t-test and Mann-Whitney U test. Results: After 12-hour shifts were initiated, job satisfaction significantly increased (t=3.93, p<.001) and QOL was higher for nurses on 12-hour shifts compared to 8-hour (t=7.83, p<.001). There was no statistically significant change in incident report rate ($x^2=0.15$, p=.720). The overtimes decreased from $36.3{\pm}34.7$ to $17.3{\pm}34.9$ minutes (Z=-8.91, p<.001). Conclusion: These results provide evidence that 12-hour shifts can be an effective ways of scheduling for staff nurses to increase job satisfaction and quality of life without increasing patient safety incidents or prolonged overtime work hours.

• 디지털융복합연구
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• 제12권2호
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• pp.423-430
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• 2014

환자안전 문화에 대한 종합병원 방사선사의 인식을 조사하여 방사선사의 환자안전관리를 위한 기반을 제공하고 안전 활동을 위한 프로그램을 개발하는데 기초자료로 제공하고자 한다. 환자안전 문화에 대한 종합병원 방사선사의 인식을 조사하여, 본 연구의 조사기간은 2012년 6월 13일부터 6월 20일까지 대전광역시 소재 5개 종합병원에 근무하는 방사선사들을 대상으로 198명의 자료를 분석하였다(SPSS 19.0v). 환자안전 활동에 영향을 미치는 요인을 부서 내, 직속상관, 의사소통, 의료사고, 병원 별, 환자안전도에 대한 안전문화와 보고된 사고, 위험하다고 느끼는 환자 안전사고, 가장 많이 발생한 환자 안전사고를 평가한 결과 의료사고 보고체계에 따른 환자안전 문화에 관한 인식에서는 근무기간 25년 이상에서 가장 높게 나타났고 환자안전도 평가에서는 근무기간 10년~15년에서 가장 높게 나타났다. 그러므로 종합병원 방사선사의 환자안전문화를 개선하기 위해서는 충분한 인력 배치, 환자안전문제에 대한 적극적인 접근, 그리고 안전사고의 재발 방지를 위해 방사선사의 근무기간을 고려한 임무 부여 등으로 체계적인 의료사고 보고 체계를 활성 시켜야 할 것이다.

• 한국의료질향상학회지
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• 제15권2호
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• pp.107-120
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• 2009

Background : To estimate fall incidence rate and associated factors in inpatients from a general hospital. Method : The data were collected from 104 fall incident reports developed by the patient safety committee in a general hospital in Seoul from 01 January 2007 to 31 December 2008. Information included general characteristics of patients, factors related to fall, types, places, circumstances and outcomes of fall. Result : The incidence rate of fall, which was 4.4 per 1,000 total discharged patients and 0.5 per 1,000 patient-days, was much lower than that of several hospitals in the United States. The difference may reflect the different incidence reporting system of each hospital. Fall-prone patients were, in general, $$\geq_-$$65 years of age, had an alert mental status, were ambulatory with some assistance, and were dependent on and ambulatory device. High incidence of falls was associated with patients with circulatory disease. The majority of fall events usually occurred in bed or at the bedside in the patient's room, and occurred more often during the night than during the day or evening. Risk factors of fall were use of drugs (antihypertensive or neuropsychiatric drugs) and environmental factors (e.g., overly high bed height, surrounding objects, inadequate fitness shoes and slippery floor). Physical injury occurred in 43.3% of fall events, which typically required diagnosis of injury and treatment such as suturing. Risk factors for repeated falls were use of a neuropsychiatric drug (odds ratio=13.9) and gait disturbance (odds ratio=91.2). Risk factors for fall-related injury were alert mental status (odds ratio=3.3 times more likely to fall than those who were drowsy or in a stupor) and general weakness(odds ratio=3.3 times more likely to fall than those who were not generally weak). Conclusion : Medical and nursing staff should be aware of the fall risk factors of hospitalized patients and should intensively pursue preventative strategies. Development of fall prevention education based on these results is recommended.

• Perspectives in Nursing Science
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• 제10권2호
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• pp.158-166
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• 2013

Purpose: This study was conducted to investigate patient safety regulations and guidelines in order to understand their current status, and to examine support measures to improve patient safety in Korean hospitals. Methods: The participants were the safety officers from hospitals with 200 or more beds and 112 hospitals responded to the online survey. The questions covered patient safety regulations, the performance level of patient safety activities, patient safety incident reporting systems, the dedicated professional, training, support mechanisms, and expectations of reporting systems. Results: Among preventative measures, fall prevention and hand hygiene were reported to be most widely practiced (92% and 91%, respectively). Time-out for invasive procedures showed a relatively low practice rate at 70%. Among patient care activities, transfusion, surgery and sedation, medication, and infection management were performed by 84, 74, 93 and 93% of the hospitals, respectively. Patient safety activities included patient safety committee, patient safety cooperation between decision-making bodies, patient safety workshops, seminars, lectures, and training for employees. Conclusion: Patient safety regulations and guidelines have not yet been sufficiently prepared, and a public institution such as a certification authority is of crucial importance to enforce these guidelines.

• 임상간호연구
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• 제26권2호
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• pp.131-140
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• 2020

Purpose: This study aims to describe the characteristics of safety incidents and factors associated with injury for patients with Home Mechanical Ventilation (HMV) at the hospital. Methods: This is a retrospective study. Data were collected from the work log of respiratory home care nurses and the patients' electronic medical records were investigated. In order to compare group differences, independent t-test and χ² test were used. Associated factors with injury development were identified by generalized mixed modeling analysis controlling for age and gender. Results: A total of 304 patients on HMV were included in this study, among which 129 (42.4%) experienced 352 HMV-related incidents. Mean frequency of incidents for each patient was 5.11±3.98, ranged from 1 to 15 times. In 19.0% of the incidents, injury was developed. Types of incident and persons involved in the incidents were significantly associated with the patient's injury. In the case of the safety incidents, patient's injury was significantly higher in accidents caused by respiratory circuit problems compared to those caused by problems with the ventilator operation by the medical staff (coefficient=1.25, p=.020). In addition, in the case of those involved in the safety incidents, patient's injury was significantly higher in the accident caused by the patient family members or caregivers than that caused by the medical personnel (coefficient=1.25, p=.019). Conclusion: In order to minimize injury caused by incidents in patients with HMV, hospitals need to provide systemic education to their medical staff and caregivers to enhance awareness of the importance of reporting and safety management.

• 대한지역사회영양학회지
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• 제15권2호
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• pp.275-283
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• 2010

There are few studies reporting optimal waist circumference that can be utilized to prevent the incidence of cardiovascular disease (CVD). We evaluated the association of waist circumference and waist and hip circumference ratio (WHR) with incident cases of CVD developed over 6 years in a population-based prospective study including Korean adults. Analyses for receiver-operating characteristic (ROC) curve were performed with data for 1,733 men and 1,579 women who were aged 40 to 69 years and were free of a physician-diagnosis of CVD at baseline. Information on the diagnosis of CVD was periodically reported using interviewer-administered questionnaires and anthropometric measures were obtained by biennial health examinations. We newly identified 77 cases of CVD during a follow-up period between 2003 and 2008. On the basis of measures of diagnostic accuracy including minimum distance to ROC curve and Youden index, waist circumference of 85 cm for men, in particular for male nonsmokers, and of 80 cm for women and WHR of 0.88 to 0.90 for men and of 0.83 for women were found to be optimal cutoff points to identify individuals at CVD risks. The study also found that the use of the suggested optimal values for waist circumference show higher sensitivity and lower specificity compared with 90 cm for men and 85 cm for women, which are waist cutoff points given by the Korean Society for the Study of Obesity to define abdominal obesity for Korean adults. Although lower cutoff points of waist circumference (83 cm) and WHR (0.87) were observed to be optimal for male smokers compared with male nonsmokers, whether suggesting waist cutoff points specific to smokers is needed warrants further studies. After taking into account other cardiovascular risk factors including smoking, men with waist circumference of 85 cm or greater and women with 80 cm or greater were at an increased risk of CVD. Thus, these cutoff points of waist circumference may be able to capture more individuals at CVD risks contributing to the prevention of future development of CVD.