가정용 인공호흡기 관련 안전사고 특성 및 손상 영향 요인 분석: 상급종합병원 일반병동 환자 중심으로
Factor Associated with Injury Related to Home Mechanical Ventilation in General Ward Patients: A Retrospective Study
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목적: 본 연구는 상급종합병원의 일반병동에 입원한 가정용 인공호흡기 적용 환자를 대상으로 이들에게 발생한 안전사고의 특성과 손상의 정도를 파악하고, 안전사고로 인한 손상에 영향을 미치는 요인을 확인하는 것이다. 방법: 가정용 인공호흡기 관리간호사의 업무일지, 환자의 전자 진료 기록에서 수집된 데이터를 후향적으로 조사하였다. 그룹 차이를 비교하기 위해 independent t-test 및 χ2 test을 이용하여 분석하였다. 손상 관련된 영향 요인은 개인내 상관성을 고려한 일반화 혼합모형 분석을 이용하였으며, 개인의 연령과 성별을 보정하고 영향 요인을 확인하였다. 결과: HMV관련 안전사고 유형과 안전사고 발생에 관련된 대상자가 안전사고로 인한 환자의 손상에 유의한 영향을 미치는 것으로 나타났다. 이번 연구에는 총 304명의 HMV 환자가 포함되었으며, 이 중 129명(42.4%)이 352건의 안전사고를 경험하였다. 환자별 평균 사고 빈도는 5.11 (±3.98)이며 범위는 1~15건수였다. 19.0%에서 안전사고로 인한 손상이 발생하였다. 안전사고 유형의 경우 의료진의 인공호흡기 조작 문제로 인한 사고에 비해 호흡기 회로 문제로 인해 발생한 사고에서 환자의 손상 발생이 유의하게 높게 나타났다(coefficient=1.25, p=.020). 또한 안전사고 발생에 관련된 대상자의 경우, 의료인으로 인해 발생한 사고에 비해 간병인 또는 보호자로 인해 발생한 사고에서 환자의 손상 발생이 유의하게 높은 것으로 나타났다(coefficient=1.25, p=.019). 결론: 안전사고로 인한 손상 발생을 최소화하기 위해서 의료진을 비롯한 보호자와 돌봄 제공자를 대상으로 적절한 가정용 인공호흡기 관리 교육과 더불어 보고의 중요성과 안전 관리의 인식을 강화하기 위한 체계적인 교육이 필요하다.
Abstract
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 x2 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.
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