• Journal of Korean Academy of Nursing Administration
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• v.12 no.3
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• pp.397-405
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• 2006

Purpose: The purpose of this study was to develop the medical error reporting system and to validate an trait of error in the Operating Room. Methods: Descriptive research design was used. The subjects were 30 nurses with below 5-year-career in a University Hospital. Data was collected from 11, April until 22, April, 2005 using web-based error reporting system. Data was analyzed by mean, standard deviation, $X^{2}-test$ using SPSS WIN 10.0 program. Results: A time of medical error in operating room nursing frequent occurrence was from 12 pm. to 4pm. 'Lack of sterile materials' management' was the best frequent occurrence of medical error in operating room nursing. Conclusion: The findings of this study show that manager of healthcare organization must develop the error reporting system more familiar and ordinary. Afterward, we prevent the repetitive medical errors in nursing care through analyzing of error reporting system.

• Korean Journal of Adult Nursing
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• v.25 no.6
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• pp.633-643
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• 2013

Purpose: The objective of this study was to identify the moderating and mediating effects of transformational-leadership in the relationship between medication error management climate and error reporting intention. Methods: Participants in this study were 118 nurses from 11 hospitals in Korea. The scales of medication error management climate, transformational-leadership and error reporting intention of nurses were used in this study. Descriptive statistics, t-test, ANOVA, partial Pearson correlation coefficient, and stepwise multiple regression were used for data analysis. Results: Higher transformational leadership group members had higher error management climate (t=3.88~4.64, p<.001) and higher intention to error reporting (t=2.49, p=.014). There were significant positive correlations between subcategories of medication error management climate and transformational leadership (r=.37~.51, p<.001). But error reporting intention was related to the transformational leadership (r=.28 p=.002), two subcategories such as 'learn from error' (r=.26, p=.004) and 'medication error competence' (r=.25, p=.008) of medication error management climate. Transformational-leadership was a moderator and a mediator between medication error management climate and error reporting intention. Conclusion: Based on the results of this study, transformational-leadership promotion training program to construct medication error management climate and to improve error reporting intention should be needed.

• Quality Improvement in Health Care
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• v.18 no.1
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• pp.57-70
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• 2012

Background : The purpose of this study was to understand healthcare workers' perception of patient safety culture and medical error reporting to provide basic resources for the settlement of patient safety culture in medical institutions in Korea. Methods : For this purpose, convenience sampling by self-selection was applied to healthcare workers at a university hospital in Gyeonggi-do and a total of 482 people responded. The survey used the translated version of AHRQ in Korean and distributed through the Intranet system of the hospital. Result : The ratio of positive response was low overall. Among the responses, the response for 'Nonpunitive Response to Error' was the lowest at 17.7%, followed by the responses for 'Staffing' at 21.3%, 'Handoffs & Transitions' at 32.9%, and 'Communication Openness' at 44.3%. In result of surveying whether the responders have reported patient safety incidents during the past 12 months, 68.3% responded 'not once.' Conclusion : The perception of healthcare workers' patient safety culture and medical error reporting, when compared to AHRQ, was lower overall. It is important for healthcare workers to pay greater attention to patient safety to create a safe hospital culture where they do not punish or criticize related individuals or departments.

• Health Policy and Management
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• v.15 no.4
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• pp.110-135
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• 2005

The objectives of this study were (1) to describe doctors' perception and attitudes toward patient safety culture and medical error reporting in their working unit and hospitals, (2) to examine whether these perception and attitudes differ by doctors' characteristics, such as sex, position, and specialties, and (3) to understand the relationship between overall perception of patient safety in their working unit and each sub domain of patient safety culture. A survey was conducted with 135 doctors working in a university hospital in Korea. After descriptive analyses and chi-square tests of subgroup differences, a multivariate-regression of overall perception of patient safety in their unit with sub-domains of patient safety culture was conducted. Overall, a significant proportion of doctors expressed negative perception of their working units' patient safety culture, many reporting potentials for patient safety problems to occur in their unit. They also negatively viewed their hospital leadership's commitment on patient safety. Regarding the patient safety in their working unit, doctors were most worried about staffing level and observance of safety procedures. Most doctors did not know how and which medical error to report. They also perceived that medical errors would work against them personally and penalize them. About 22 percent of respondents believed that even seriously harmful medical errors were not reported.

• Journal of Korean Academy of Nursing
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• v.37 no.2
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• pp.185-191
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• 2007

Purpose. The purpose of this study was to develop and evaluate an error reporting promoting program(ERPP) to systematically reduce the incidence rate of nursing errors in operating room. Methods. A non-equivalent control group non-synchronized design was used. Twenty-six operating room nurses who were in one university hospital in Busan participated in this study. They were stratified into four groups according to their operating room experience and were allocated to the experimental and control groups using a matching method. Mann-Whitney U Test was used to analyze the differences pre and post incidence rates of nursing errors between the two groups. Results. The incidence rate of nursing errors decreased significantly in the experimental group compared to the pre-test score from 28.4% to 15.7%. The incidence rate by domains, it decreased significantly in the 3 domains-"compliance of aseptic technique", "management of document", "environmental management" in the experimental group while it decreased in the control group which was applied ordinary error-reporting method. Conclusion. Error-reporting system can make possible to hold the errors in common and to learn from them. ERPP was effective to reduce the errors of recognition-related nursing activities. For the wake of more effective error-prevention, we will be better to apply effort of risk management along the whole health care system with this program.

• Korean Journal of Radiology
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• v.22 no.10
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• pp.1587-1593
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• 2021

• The Journal of the Convergence on Culture Technology
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• v.4 no.2
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• pp.33-42
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• 2018

The Patient Safety Act was enacted on July 26, 2016. Patient safety law is a method to prevent harm by collecting and accumulating various errors through the reporting system. Therefore, in order for this law to be successfully implemented, it is necessary to vitalize 'the autonomous reporting and reporting learning system of patient safety accidents'. And In order for this system to be activated, a large amount of reporting data accumulation is a prerequisite. Nevertheless, there were only two reports in about 17 months. In this paper, I will criticize the validity of the current autonomous reporting system and the two proposed amendments, I would like to propose the introduction of a partial obligation reporting system.

• Journal of Korean Academy of Nursing
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• v.40 no.2
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• pp.172-181
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• 2010

Purpose: The purpose of this study was to examine the impact of strategies to promote reporting of errors on nurses' attitude to reporting errors, organizational culture related to patient safety, intention to report and reporting rate in hospital nurses. Methods: A nonequivalent control group non-synchronized design was used for this study. The program was developed and then administered to the experimental group for 12 weeks. Data were analyzed using descriptive analysis, $\chi^2$-test, t-test, and ANCOVA with the SPSS 12.0 program. Results: After the intervention, the experimental group showed significantly higher scores for nurses' attitude to reporting errors (experimental: 20.73 vs control: 20.52, F=5.483, p=.021) and reporting rate (experimental: 3.40 vs control: 1.33, F=1998.083, p<.001). There was no significant difference in some categories for organizational culture and intention to report. Conclusion: The study findings indicate that strategies that promote reporting of errors play an important role in producing positive attitudes to reporting errors and improving behavior of reporting. Further advanced strategies for reporting errors that can lead to improved patient safety should be developed and applied in a broad range of hospitals.

• Quality Improvement in Health Care
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• v.22 no.2
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• pp.75-90
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• 2016

Objectives: This study measures the level of cognition of employee's patient safety culture and evaluates the current level through comparing the results to external levels. Ultimately it is performed to construct a strategic improvement plan through the basic database for patient's safety culture. Methods: A questionnaire survey of self reporting type was carried out using structured questionnaire of the patient's safety culture for employees currently employed in a hospital. Total responders was 1,129 and a response rate was 54.6%. The survey results were calculated with a percent positive response, and the current level was evaluated by comparing with the survey results of a hospital (2009 and 2014) and the survey result of The Agency for Healthcare Research and Quality(2014). Results: Sub-dimension of high percent positive response for each area were 'teamwork within hospital units' (80%), 'feedback & communication about error' (73%) and 'supervisor/manager expectations & actions promoting safety' (67%). Meanwhile, 'teamwork across hospital units' (31%), 'hospital management support for patient safety' (29%), 'staffing' (27%) and 'non-punitive response to error' (17%) were relatively low percent positive response. Compared to the survey results of AHRQ (2014) for each area, 'teamwork within hospital units' (80%), 'feedback & communication about error' (73%), 'frequency of event reporting' (66%) were at the top 50% percentile level and the remaining sub-dimensions showed a very low level in the lower 10% percentile area. Conclusion: In order to establish a system for patient safety culture within the hospital and evaluate the effect on this, it is necessary to periodically evaluate the patient's safety culture and establish regulations on hospital safety culture to comply with this.

• Quality Improvement in Health Care
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• v.17 no.1
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• pp.89-105
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• 2011

Background : The purpose of study in to grasp the level of perception of hospital workers on the patient safety culture, consider the difference in perception of patients safety culture according to medical service and finally find out a way to establish patient safety culture in hospital. Methods : As for the data, the analysis on frequency, t-test, ANOVA and tukey test were carried out by using SPSS 12.0. Result : The results of comparison among the positive response ratios on the patients culture of hospital workers showed that the subjects had perceived the teamwork within units most positively(74.1%), and perceived most negatively on the non-punitive response to error(16.2%)and the staffing(26.2%). 68.6% of subjects answered that the medical error were mostly of always reported. when daytime working hours are longer, perception of patient safety culture ranked low. In general, departments for direct medical service than departments for indirect medical service assessed patient safety culture high. Conclusion : Organizational learning and teamwork within units, communication openness, active support of hospital management for patient safety, and cooperation across the units would be crucial to promote the overall perceptions of patients safety of hospital workers and the level of patients safety in the units and to improve the quality of the event reporting system.