การพัฒนารูปแบบการบริหารความเสี่ยงของคลินิก หู คอ จมูก โรงพยาบาลสงขลานครินทร์

Abstract

This practical action research aimed to develop and apply a risk management model at the ENT Clinic, Songkhlanagarind Hospital. The conceptual framework used in this research was the systematic framework developed by Donabedian (2005). The research process was based on the action research proposed by Kemmis and McTaggart (Kemmis & McTaggart, 2014).The research methods consisted of 3 phases: 1) studying the situation, 2) developing the risk management model, and 3) evaluating the use of the model. Thirty one participants were recruited using purposive sampling. Data collection methods were group discussion, observation, semi structured interviews, and questionnaires. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using content analysis. The results revealed that the risk management model of ENT clinic at Songklanagarind Hospital focused on risk surveillance at all service points by nursing personnel with risk management competency. The process of model development consisted of 3 parts: 1) structuring; the communication of putting risk policies into action, the competency development of the personnel with clinical skills and non clinical skills, 2) developing an instrument; the preparation of risk management manuals in compliance with 9 necessary standards of safety for ENT clinics, the guidelines for risk communication with the patient care team, and 3) screening the use of the model; screening the process at every service point, visiting the service points, providing environment to reduce risks and promote a safe working climate. The process of evaluation found that topics with the greatest potential for implementation were: applicability to all patient groups (M = 4.4, SD = 0.5), response to the risk problems to be solved and work values (M = 4.4, SD = 0.5),and suitability to the ENT clinic (M = 4.20, SD = 0.42). The overall mean score of the possibility of adopting the risk management model into practice was high (M = 4.13, SD = 0.34).The percentage of the observed practice of the risk management guidelines collected from all service points for one month revealed that 89.46 % practiced, (8) while 10.54% did not. 3) The numbers of incidents that occurred after using the risk management model were:10 for level A (an event with a probability of causing error), 5 for Level B,(an error but not reaching the patient), and 1 for Level D, (an error with a patient). No moderate or severe incidents were observed.Compared to months without the risk management model, no recurrence of severe incidents was found. Overall, patient safety improved.The Number of incident reports was increased leading to a more comprehensive solution. Nurse administrators can apply the results of this study to improve the quality of nursing care and increase patient safety.