بررسی تاثیر مداخلات اعتباربخشی بر سنجه‌ی ایمنی بیمار در اتاق‌های عمل یکی از بیمارستان‌های تامین اجتماعی تهران
محورهای موضوعی : -مدیریت خدمات بهداشتی و درمانی
زین العابدین آقائی تلیکانی
1
,
لیلا ریاحی
2
,
امیر اشکان نصیری پور
3
1 - دانشجوی کارشناسی ارشد مدیریت خدمات بهداشتی درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
2 - دانشیار، گروه مدیریت خدمات بهداشتی درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران (نویسنده مسئول)
3 - دانشیار، گروه مدیریت خدمات بهداشتی درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
کلید واژه: اعتباربخشی, سری زمانی منقطع, اتاق عمل, ایمنی بیمار, سنجه, بیمارستان تامین اجتماعی,
چکیده مقاله :
مقدمه: اعتباربخشی به معنی ارزشیابی سیستماتیک مراکز اراِئه خدمات سلامت با استانداردهای مشخص است. هدف کلی این پژوهش بررسی تاثیر مداخلات اعتباربخشی بر سنجه ایمنی بیمار در اتاق‌های عمل یکی از بیمارستان‌های تامین اجتماعی تهران بوده است.روش پژوهش: پژوهش حاضر از منظر نتیجه، کاربردی و روش اجرا ،تحلیلی و زمان به صورت مقطعی صورت گرفته است. جامعه آماری، منابع اطلاعاتی مربوط به سنجه ایمنی بیمار است و نمونه‌گیری آن در بازه زمانی سال 1391-1399 است. روش نمونه‌گیری بصورت تمام شماری و شامل کلیه اطلاعات مربوط به این بازه زمانی می‌باشد. ابزا گرداوری داده، فیش کارت بوده که با روش کتابخانه‌ای از منابع و مراکز تهیه داده با هماهنگی دفتر بهبود کیفیت و واحد آمار بیمارستان استخراج شده است. تحلیل داده‌ها با استفاده از نرم‌افزار SPSSو روش تحلیل سری‌های زمانی منقطع انجام شد.یافته‌ها: یافته‌های تحلیل سری زمانی، پژوهش در ۳ قالب تاثیر افزایشی، تاثیر کاهشی و بی تاثیر بودن طرح اعتبار بخشی بر سنجه‌ها گزارش شده است. در سنجه ایمنی بیمار نتایج حاصل از جدول رگرسیون قطعه‌ای نشان داده است که در ابتدای دوره بررسی، متوسط سنجه ایمنی بیمار 34/76 درصد بوده است. تغییرات ماهانه سنجه ایمنی بیمار، قبل از مداخله معنی‌دار نبوده است (43/۰= P). بعد از مداخله نیز سطح میانگین سنجه ایمنی بیمار، تغییر ناگهانی و معناداری نداشته است (42/0=P). هم‌چنین اختلاف روند (شیب) سنجه ایمنی بیمار، قبل و بعد از مداخله تغییر معناداری نداشته است (31/0=P). به طوری که سنجه ایمنی بیمار بعد از مداخله اول به طور فصلی 06/1 درصد افزایش داشته است. به طور کلی نتایج حاصل از پژوهش نشان داده است که، در نتیجه اجرای طرح اعتباربخشی سنجه ایمنی بیمار افزایش یافته‌اند.نتیجه‌گیری: نتایج پژوهش نشان داده است که، اجرای مداخلات سنجه‌های اعتباربخشی بر روی سنجه ایمنی بیمار تاثیر دارد. تعداد سنجه‌های معنادار از سال 1395 تا 1399، نشان می‌دهد که ویرایش‌های سوم و چهارم استانداردهای اعتبار بخشی ملی بیمارستان‌های ایران موثر بوده است. بر اساس تحلیل‌های صورت گرفته پیشنهاد می‌شود: سنجه ایمنی بیمار بعد از مداخله اول افزایش پیدا کند.بنابراین اجرای اعتباربخشی در بیمارستان‌ها به مدیران پیشنهاد می‌گردد.
Introduction: Accreditation means the systematic evaluation of health care centers with specific standards. The overall purpose of this study was to investigate the effect of accreditation interventions on patient safety measurement in operating rooms of one of the social security hospitals in Tehran.Methods: The present study is cross-sectional in terms of result, application and implementation method, analytical and time. The statistical population is information sources related to the patient safety measure and its sampling is in the period 1391-1399. The sampling method is numerical and includes all the information related to this time period. Data collection tools are receipts that have been extracted by library method from data sources and data centers in coordination with the Quality Improvement Office and the hospital statistics unit. Data analysis was performed using SPSS software and intermittent time series analysis method.Results: Findings of time series analysis, research has been reported in three forms of incremental effect, decreasing effect and ineffectiveness of the accreditation scheme of the scales. In the patient's safety measure, the results of the fragmentary regression table showed that at the beginning of the study period, the average patient's safety measure was 76.34%. Monthly changes in patient's safety measure were not significant before the intervention (P = 0.43). After the intervention, the mean level of the patient's safety measure did not change suddenly and significantly (P = 0.42). Also, the difference in the trend (slope) of the patient's safety measure before and after the intervention did not change significantly (P = 0.31). But the results showed that after the first intervention, the trend (slope) of the patient's average safety measurement changed significantly (P = 0.000); So that the patient's safety measure after the first intervention has increased seasonally by 1.06%. In general, the results of the study have shown that, as a result of the implementation of the accreditation scheme, the patient's safety measure has increased.Conclusion: The results show that the implementation of accreditation measures has an effect on patient safety measures. The number of significant measures from 2016 to 2016 shows that the third and fourth editions of the national accreditation standards of Iranian hospitals have been effective. Based on the analyzes performed, it is recommended that the patient's safety measure be increased after the first intervention. Therefore, the implementation of accreditation in hospitals is recommended to managers.
1- Mossadegh Rad, Mohammad A, Sari A, Ali, Yousefinejadi, Taneh. Evaluation of the effects of accreditation in hospitals. Journal of Faculty of Medicine, Tehran University of Medical Sciences, 2019; 76(12): 12-804. [in persian]
2- Alkhenizan A, Shaw C. Impact of accreditation on the quality of healthcare services: a systematic review of the literature. Annals of Saudi medicine, 2011; 31(4): 407-416.
3- Amini M, Sanjary L, Vasei M, Alavi S. Frequency evaluation of the nosocomial infections and related factors in Mostafa Khomeini Hospital" ICU" based on" NNI" system. JAUMS, 2009; 7(1): 9-14. [in persian]
4- Teng CI, Dai YT, Lotus Shyu YI, Wong MK, Chu TL, Tsai YH. Professional commitment, patient safety, and patient‐perceived care quality. Journal of Nursing Scholarship, 2009; 41(3): 301-309.
5- El-Jardali F, Jamal D, Dimassi H, Ammar W, Tchaghchaghian V. The impact of hospital accreditation on quality of care: perception of Lebanese nurses. International Journal for Quality in Health Care, 2008; 20(5): 363-71. [in persian]
6- Schmaltz SP, Williams SC, Chassin MR, Loeb JM, Wachter RM. Hospital performance trends on national quality measures and the association with Joint Commission accreditation. Journal of hospital medicine, 2011; 6(8): 454-61.
7- Ng K, Leung GK, Johnston JM, Cowling BJ. Factors affecting implementation of accreditation programmes and the impact of the accreditation process on quality improvement in hospitals: a SWOT analysis. Hong Kong Medical Journal; 2013.
8- Mate KS, Rooney AL, Supachutikul A, Gyani G. Accreditation as a path to achieving universal quality health coverage. Globalization and health, 2014; 10(1): 1-8.
9- Sack C, Scherag A, Lütkes P, Günther W, Jöckel K-H, Holtmann G. Is there an association between hospital accreditation and patient satisfaction with hospital care? A survey of 37 000 patients treated by 73 hospitals. International Journal for Quality in Health Care, 2011; 23(3): 278-83.
10- Haj-Ali W, Karroum LB, Natafgi N, Kassak K. Exploring the relationship between accreditation and patient satisfaction–the case of selected Lebanese hospitals. International journal of health policy and management, 2014; 3(6): 341. [in persian]
11- Fiorio CV, Gorli M, Verzillo S, valuating organizational change in health care: the patient-centered hospital model, MC Health, 2018; 95; 7-22.
12- Agrizzi D, Jaafaripooyan E, Akbarihaghighi F. Key Performance Indicators (KPIs) for healthcare accreditation system; 2010.
13- Andres EB, Song, W, Song W, Johnston JM. H Can hospital accreditation enhance patient experience? Longitudinal evidence from a Hong Kong hospital patient experience survey, 2019; 3(6): 344-346.
14- Jovanovic B. Hospital accreditation as method for assessing quality in health care. Archive of Oncology, 2005; 13(3/4): 156.
15- Headrick LA, Barton AJ, Ogrinc G, Strang C, Aboumatar HJ, Aud MA, et al. Results of an effort to integrate quality and safety into medical and nursing school curricula and foster joint learning. Health Affairs, 2012; 12(31): 266-280.
16- Hirschhorn LR, Baynes C, Sherr K, Awoonor-Williams J, Finnegan K, Philips J, Anatole M, Bawah A, Basinga P. Approaches to ensuring and improving quality in the context of health system strengthening: a cross-site analysis of the five African Health Initiative Partnership programs, BMC Health Services Research, 2013; 13(2): 32-45.
17- Alkhenizan A, Shaw C. Impact of accreditation on the quality of healthcare services: a systematic review of the literature. Annals of Saudi medicine, 2011; 31(4): 407-16.
18- Nasiripour A, Amirashkan, Kashani Hash, Rabiei. Development of strategies to improve patient safety in the clinical departments of 15 Khordad Hospital in Tehran. Health management, 2010; 2(34): 7-16. [in persian]
19- Mugada V, Devineni RC, Pendyala RM, Vempati D, Kuchi S. Categorization, appraisal, and reporting of medication errors ascertained in medical ward of tertiary care hospital. Journal of Applied Pharmaceutical Science, 2018; 8(05): 109-14.
20- Wolfe D, Yazdi F, Kanji S, Burry L, Beck A, Butler C, Esmaeilisaraji L, Hamel C, Hersi M, Skidmore B, Moher D, Hutton B. Todd Incidence, causes, and consequences of preventable adverse drug reactions occurring in inpatients: A systematic review of systematic reviews, 2018; 13(10): 1-10.
21- Runciman WB, Roughead EE, Semple SJ, Adams RJ. Adverse drug events and medication errors in Australia. International Journal for Quality in Health Care, 2003; 15(suppl): i49-i59.
22- Nair RP, Kappil D, Woods TM. PHARMACIST TO PHARMACIST-10 Strategies for Minimizing Dispensing Errors-Dispensing errors can be costly for the pharmacist as well as potentially dangerous for the patient. Pharmacists can take simple steps to help eliminate this problem. Pharmacy Times, 2010; 76(1): 92.
23- Mohammadil M, Matin BK, Riahi L. The impacts of the hospital accreditation on the education of manpower in Imam Reza Hospital. Advances in Environmental Biology; 2014: 318-25. [in persian]
24- Bahmaei J, Bastani P, Keshtkaran A, Mohammadpour M, Sarikhani Y. Challenges of the Execution of Hospital Accreditation in Iran: A Critical Review. Journal of health research in community, 2020; 5(4): 82-98. [in persian]
25- Kristensen S, Mainz J, Bartels P. Selection of indicators for continuous monitoring of patient safety: recommendations of the project ‘safety improvement for patients in Europe’. International Journal for Quality in Health Care, 2009; 21(3): 169-75.
26- Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiologica Scandinavica, 2009; 53(2): 143-51.
27- Fadda J. Quality of Healthcare: A Review of the Impact of the Hospital Physical Environment on Improving Quality of Care, Sustainable Building for a Cleaner Environment, 2018; 13(2): 34-45.
28- Salehian M, Riahi L, Biglarian A. The impact of accreditation on productivity indexes in Firoozgar hospital in Tehran. Journal of Health Administration, 2015; 18(60): 79-89. [in persian]
29- Mate KS, Rooney AL, Supachutikul A, Gyani G. Accreditation as a path to achieving universal quality health coverage. Globalization and health, 2014; 10(1): 1-8.
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1- Mossadegh Rad, Mohammad A, Sari A, Ali, Yousefinejadi, Taneh. Evaluation of the effects of accreditation in hospitals. Journal of Faculty of Medicine, Tehran University of Medical Sciences, 2019; 76(12): 12-804. [in persian]
2- Alkhenizan A, Shaw C. Impact of accreditation on the quality of healthcare services: a systematic review of the literature. Annals of Saudi medicine, 2011; 31(4): 407-416.
3- Amini M, Sanjary L, Vasei M, Alavi S. Frequency evaluation of the nosocomial infections and related factors in Mostafa Khomeini Hospital" ICU" based on" NNI" system. JAUMS, 2009; 7(1): 9-14. [in persian]
4- Teng CI, Dai YT, Lotus Shyu YI, Wong MK, Chu TL, Tsai YH. Professional commitment, patient safety, and patient‐perceived care quality. Journal of Nursing Scholarship, 2009; 41(3): 301-309.
5- El-Jardali F, Jamal D, Dimassi H, Ammar W, Tchaghchaghian V. The impact of hospital accreditation on quality of care: perception of Lebanese nurses. International Journal for Quality in Health Care, 2008; 20(5): 363-71. [in persian]
6- Schmaltz SP, Williams SC, Chassin MR, Loeb JM, Wachter RM. Hospital performance trends on national quality measures and the association with Joint Commission accreditation. Journal of hospital medicine, 2011; 6(8): 454-61.
7- Ng K, Leung GK, Johnston JM, Cowling BJ. Factors affecting implementation of accreditation programmes and the impact of the accreditation process on quality improvement in hospitals: a SWOT analysis. Hong Kong Medical Journal; 2013.
8- Mate KS, Rooney AL, Supachutikul A, Gyani G. Accreditation as a path to achieving universal quality health coverage. Globalization and health, 2014; 10(1): 1-8.
9- Sack C, Scherag A, Lütkes P, Günther W, Jöckel K-H, Holtmann G. Is there an association between hospital accreditation and patient satisfaction with hospital care? A survey of 37 000 patients treated by 73 hospitals. International Journal for Quality in Health Care, 2011; 23(3): 278-83.
10- Haj-Ali W, Karroum LB, Natafgi N, Kassak K. Exploring the relationship between accreditation and patient satisfaction–the case of selected Lebanese hospitals. International journal of health policy and management, 2014; 3(6): 341. [in persian]
11- Fiorio CV, Gorli M, Verzillo S, valuating organizational change in health care: the patient-centered hospital model, MC Health, 2018; 95; 7-22.
12- Agrizzi D, Jaafaripooyan E, Akbarihaghighi F. Key Performance Indicators (KPIs) for healthcare accreditation system; 2010.
13- Andres EB, Song, W, Song W, Johnston JM. H Can hospital accreditation enhance patient experience? Longitudinal evidence from a Hong Kong hospital patient experience survey, 2019; 3(6): 344-346.
14- Jovanovic B. Hospital accreditation as method for assessing quality in health care. Archive of Oncology, 2005; 13(3/4): 156.
15- Headrick LA, Barton AJ, Ogrinc G, Strang C, Aboumatar HJ, Aud MA, et al. Results of an effort to integrate quality and safety into medical and nursing school curricula and foster joint learning. Health Affairs, 2012; 12(31): 266-280.
16- Hirschhorn LR, Baynes C, Sherr K, Awoonor-Williams J, Finnegan K, Philips J, Anatole M, Bawah A, Basinga P. Approaches to ensuring and improving quality in the context of health system strengthening: a cross-site analysis of the five African Health Initiative Partnership programs, BMC Health Services Research, 2013; 13(2): 32-45.
17- Alkhenizan A, Shaw C. Impact of accreditation on the quality of healthcare services: a systematic review of the literature. Annals of Saudi medicine, 2011; 31(4): 407-16.
18- Nasiripour A, Amirashkan, Kashani Hash, Rabiei. Development of strategies to improve patient safety in the clinical departments of 15 Khordad Hospital in Tehran. Health management, 2010; 2(34): 7-16. [in persian]
19- Mugada V, Devineni RC, Pendyala RM, Vempati D, Kuchi S. Categorization, appraisal, and reporting of medication errors ascertained in medical ward of tertiary care hospital. Journal of Applied Pharmaceutical Science, 2018; 8(05): 109-14.
20- Wolfe D, Yazdi F, Kanji S, Burry L, Beck A, Butler C, Esmaeilisaraji L, Hamel C, Hersi M, Skidmore B, Moher D, Hutton B. Todd Incidence, causes, and consequences of preventable adverse drug reactions occurring in inpatients: A systematic review of systematic reviews, 2018; 13(10): 1-10.
21- Runciman WB, Roughead EE, Semple SJ, Adams RJ. Adverse drug events and medication errors in Australia. International Journal for Quality in Health Care, 2003; 15(suppl): i49-i59.
22- Nair RP, Kappil D, Woods TM. PHARMACIST TO PHARMACIST-10 Strategies for Minimizing Dispensing Errors-Dispensing errors can be costly for the pharmacist as well as potentially dangerous for the patient. Pharmacists can take simple steps to help eliminate this problem. Pharmacy Times, 2010; 76(1): 92.
23- Mohammadil M, Matin BK, Riahi L. The impacts of the hospital accreditation on the education of manpower in Imam Reza Hospital. Advances in Environmental Biology; 2014: 318-25. [in persian]
24- Bahmaei J, Bastani P, Keshtkaran A, Mohammadpour M, Sarikhani Y. Challenges of the Execution of Hospital Accreditation in Iran: A Critical Review. Journal of health research in community, 2020; 5(4): 82-98. [in persian]
25- Kristensen S, Mainz J, Bartels P. Selection of indicators for continuous monitoring of patient safety: recommendations of the project ‘safety improvement for patients in Europe’. International Journal for Quality in Health Care, 2009; 21(3): 169-75.
26- Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiologica Scandinavica, 2009; 53(2): 143-51.
27- Fadda J. Quality of Healthcare: A Review of the Impact of the Hospital Physical Environment on Improving Quality of Care, Sustainable Building for a Cleaner Environment, 2018; 13(2): 34-45.
28- Salehian M, Riahi L, Biglarian A. The impact of accreditation on productivity indexes in Firoozgar hospital in Tehran. Journal of Health Administration, 2015; 18(60): 79-89. [in persian]
29- Mate KS, Rooney AL, Supachutikul A, Gyani G. Accreditation as a path to achieving universal quality health coverage. Globalization and health, 2014; 10(1): 1-8.