대한수혈학회지 : 제 28 권제 3 호, 2017 The Korean Journal of Blood Transfusion Vol. 28, No. 3, 275-281, December 2017 https://doi.org/10.17945/kjbt.2017.28.3.275 pissn 1226-9336 eissn 2383-6881 Original Article 의료기관혈액원혈액관리업무향상을위한질병관리본부교육프로그램에대한평가 - 설문조사결과분석 (2015 2017 년 )- 엄태현 1 ㆍ김현옥 2 ㆍ이미남 3 ㆍ장충훈 3 ㆍ김민주 3 ㆍ김준년 3 인제대학교일산백병원진단검사의학과 1, 연세대학교의과대학진단검사의학교실 2, 질병관리본부혈액안전감시과 3 Assessment of the Training Program for Improvement of Blood Management at Hospital Blood Centers by Korea Centers for Disease Control and Prevention -Analysis of Survey Results (2015 2017)- Tae Hyun Um 1, Hyun Ok Kim 2, Mi Nam Lee 3, Choong Hoon Jang 3, Min Joo Kim 3, Jun Nyun Kim 3 Department of Laboratory Medicine, Inje University Ilsan Paik Hospital 1, Goyang, Department of Laboratory Medicine, Yonsei University College of Medicine 2, Seoul, The Division of Human Blood Safety Surveillance, Korea Centers for Disease Control and Prevention 3, Cheongju, Korea Background: The Korea Centers for Disease Control and Prevention (KCDC) has been providing a nationwide, one-day training program for workers of hospital blood centers once a year since 2013. We evaluated the achievement levels of the program through surveys. Methods: The survey was conducted immediately after the program in 2015, 2016, and 2017. Respondents occupations, institutions, program contents, and operational aspects were asked. Results: The response rate was 56.2% 73.2%. The occupations of respondents were medical technologists 66.9% 75.7%, nurses 16.1% 22.1%, and others (administrators, et al.) 1.5% 11.3%. About 86.1% 88.2% of respondents answered that the program as a whole was satisfactory or very satisfactory; 88.9% 94.7% thought that it is necessary or very necessary; 77.9% 84.1% answered that the appropriate length of the program was one day; 53.8% 69.1% answered that the appropriate number of program is once per year; and 23.4% 53.8% or 40.3% 61.4% answered that the appropriate season for the program by the KCDC should be the first or the second quarter, respectively. Conclusion: This study suggests that the training program plays a useful role in meeting the needs of workers for hospital blood centers. (Korean J Blood Transfus 2017;28:275-281) Key words: Hospital blood center, Questionnaire, Survey Received on November 8, 2017. Revised on November 22, 2017. Accepted on November 22, 2017 Correspondence to: Tae Hyun Um Department of Laboratory Medicine, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 10380, Korea Tel: 82-31-910-7283, Fax: 82-31-910-7286, E-mail: uthmd@paik.ac.kr, ORCID: http://orcid.org/0000-0003-4879-9408 This work was supported by the Research Program funded by the Korea Centers for Disease Control and Prevention (33153004900, 33163005000, 00178034200). This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright C 2017 The Korean Society of Blood Transfusion - 275 -
Korean J Blood Transfus Vol. 28, No. 3, 275-281, Dec. 2017 서론혈액관리법에따르면혈액관리업무는수혈이나혈액제제의제조에필요한혈액을채혈, 검사, 제조, 보존, 공급또는품질관리하는업무이며, 혈액원은혈액관리업무를수행하기위하여허가를받은자를말한다. 2017년 3월현재허가를받은혈액원은총 107개소이며, 대한적십자사혈액원 15개, 대한적십자사검사센터 3개, 의료기관혈액원 62개소, 의료기관혈액공급소 27개소가있다. 혈액관리업무에대한국가의심사평가는 2006년질병관리본부에혈액안전감시과가신설되면서시작되었으며, 혈액관리업무심사평가규정 ( 보건복지부고시제2016-236호 ) 에따라진행되고있다. 우리나라에서공급하는혈액량에서의료기관혈액원이차지하는비율은점차줄어들고있다 [1]. 1994년도 2.4% 였던비율이 2004년에는 1.6% 가되었으며, 2015년에는공급혈액원인중앙대학교병원혈액원을포함하여도 0.28% 에불과하다 [2]. 의료기관혈액원중에서채혈이전혀이루어지지않는곳도증가되어 2004년 21.9% 에서 2013년에는 37.1% 로조사되었다 [3]. 채혈이이루어지지않음에도불구하고의료기관에서혈액원을유지하 려는이유는지정헌혈및자가헌혈을위한헌혈자관리의어려움과응급시신속한혈액공급, 그리고특정혈액의부족을대비하기위한것이다. 국가재난사태등과같은응급상황이발생했을때를대비하여채혈시설을확보해두는것은국가차원에서도중요한일이다. 그러나채혈을평소에경험해보지못한의료기관혈액원이갑작스러운응급상황을만나게되었을때채혈등을포함한혈액관리업무를제대로수행할것이라고기대하기는어렵다. 따라서의료기관혈액원이혈액관리업무능력을항시유지할수있는방안을국가차원에서마련할필요가있다. 질병관리본부는 2013년부터혈액관리업무담당자의역량강화를위한 혈액관리업무담당자실무교육프로그램 을제공하고있으며, 프로그램의평가와개선방안마련을위해 2015년부터피교육자대상설문조사를실시하고있다 [4]. 본연구에서는설문조사결과를분석하여프로그램의목표달성도를평가하고향후개선방안을제안하고자하였다. Table 1. Participants in the training program and survey respondents Year Hospital Blood Center* Supply Blood Center Others Total Response rate Participants 2015 108 (45.8%) 49 (20.8%) 79 (33.5%) 236 (100%) - 2016 110 (42.6%) 85 (32.9%) 63 (24.4%) 258 (100%) - 2017 135 (53.1%) 46 (18.1%) 73 (28.7%) 254 (100%) - Respondents 2015 101 (74.3%) 1 (0.7%) 34 (25.0%) 136 (100%) 57.6% 2016 84 (57.9%) 5 (3.4%) 56 (38.6%) 145 (100%) 56.2% 2017 106 (57.0%) 13 (7.0%) 67 (36.0%) 186 (100%) 73.2% *Includes Supply Blood Bank of Hospital; Include Workers for Department of Defense, Korea Centers for Disease Control and Prevention, Non-respondents. - 276 -
엄태현외 : 의료기관혈액원실무자혈액관리업무교육프로그램평가 대상및방법 1. 의료기관혈액원혈액관리업무담당자실무교육프로그램의개요 교육은 2015년부터 2017년까지매년 3 5월중에실시하였으며, 질병관리본부와혈액안전사업단의공동주관하에전국 7개적십자사혈액원 ( 서울서부, 서울남부, 서울동부, 부산, 대구경북, 광주전남, 대전세종충남 ) 에서각각 1회씩개최되었다. 교육기간은 1일이며총 7시간의교육이진행되었다. 오전에는질병관리본부담당자의혈액관리업무심사평가에대한안내와외부강사의실무중심의수혈의학관련강의로구성하였고, 오후에는대한적십자사혈액원소속전문가가헌혈및혈액제제제조관련실습교육으로구 성되었다. 피교육자는의료기관혈액원종사자이외에일부공급혈액원과국방부위탁교육자도포함되어있었다. 참석인원은 2015년, 2016년, 2017 년각각 236명, 258명, 254명이었다 (Table 1). 2. 설문조사문항교육프로그램의목표달성도를평가하고향후개선방안을도출하기위해각교육장소에서교육실시직후피교육자를대상으로설문조사를실시하였다. 조사항목은 1) 응답자의소속기관및직종, 2) 교육내용에대한사항, 3) 프로그램운영에대한사항등총 22문항으로구성하였다. 교육만족도나필요도에대한설문의답변은 5단계중하나를선택하도록하였다. Table 2. Occupations of survey respondents Year Nurse Medical technologist Medical doctor Others No-response Total 2015 26 (19.1%) 103 (75.7%) 5 (3.7%) 2 (1.5%) 0 136 (100%) 2016 32 (22.1%) 97 (66.9%) 1 (0.7%) 12 (8.3%) 3 (2.1%) 145 (100%) 2017 30 (16.1%) 135 (72.6%) 0 21 (11.3%) 0 186 (100%) Table 3. The level of satisfaction on training program contents by survey respondents Contents Year Very satisfied Satisfied Neutral Unsatisfied Very unsatisfied No-response Total Whole program 2015* 33 (24.3%) 84 (61.8%) 17 (12.5%) 0 0 2 (1.5%) 136 (100%) 2016 51 (35.2%) 78 (53.8%) 14 (9.7%) 1 (0.7%) 0 1 (0.7%) 145 (100%) 2017 51 (27.4%) 113 (60.8%) 18 (9.7%) 0 0 4 (2.2%) 186 (100%) Lectures 2015 26 (19.1%) 92 (67.6%) 17 (12.5%) 0 0 1 (0.7%) 136 (100%) 2016 44 (30.3%) 88 (60.7%) 13 (9.0%) 0 0 0 145 (100%) 2017 37 (19.9%) 127 (68.3%) 17 (9.1%) 0 0 5 (2.7%) 186 (100%) Practices* 2016 32 (22.1%) 76 (52.4%) 22 (15.2%) 1 (0.7%) 0 14 (9.7%) 145 (100%) 2017 24 (12.9%) 111 (59.7%) 35 (18.8%) 0 0 16 (8.6%) 186 (100%) *No questionnaire about practices in 2015. - 277 -
Korean J Blood Transfus Vol. 28, No. 3, 275-281, Dec. 2017 결과 1. 설문조사응답자의소속기관및직종설문조사응답률은 2015년, 2016년, 2017년각각교육이수자의 57.6%, 56.2%, 73.2% 였다. 응답자중의료기관혈액원담당자는 57.0% 74.3% 였으며, 국방부소속근무자등은 25.0% 38.6% 였다 (Table 1). 직종으로는임상병리사가 66.9% 75.7% 로가장많았고, 간호사 16.1% 22.1%, 기타 ( 행정직등 ) 이 1.5% 11.3% 였다 (Table 2). 2. 교육내용에대한설문조사결과 1) 교육내용에대한만족도전반적인교육내용에대해서 매우만족 또는 만족 한다는응답이 86.1% 88.2% 였으며, 강의에 대해서는 86.7% 91.0%, 실습에대해서는 72.6% 88.2% 였다. 불만족한다 는응답은 0% 0.7% 였으며, 매우불만족한다 는응답은없었다 (Table 3). 2) 교육의필요성교육의필요성에대해서 매우필요 또는 필요하다 는응답이 88.9% 94.7% 였다. 불필요하다 는응답은 0% 0.7% 였으며, 매우불필요하다 는응답은없었다 (Table 4). 3. 프로그램운영에대한사항 1) 프로그램진행시간전반적인프로그램시간에대해서 적당하다 는응답이 77.9% 84.1% 였으며, 강의와실습에대해서는각각 78.5% 83.8%, 79.0% 89.0% 였다. 시간이길다 는응답은강의와실습에대해각각 10.3% 10.8%, 3.7% 4.3% 였으며, 시간이 Table 4. The level of necessity for the training program perceived by survey respondents Year Very necessary Necessary Neutral Unnecessary Very unnecessary No-response Total 2015 34 (25.0%) 90 (66.2%) 10 (7.4%) 1 (0.7%) 0 1 (0.7%) 136 (100%) 2016 55 (37.9%) 74 (51.0%) 10 (6.9%) 0 0 6 (4.1%) 145 (100%) 2017 60 (32.3%) 116 (62.4%) 7 (3.8%) 1 (0.5%) 0 2 (1.1%) 186 (100%) Table 5. The appropriateness of length of training program perceived by survey respondents Contents Year Very short Short Neutral Long Very long No-response Total Whole 2015 0 3 (2.2%) 106 (77.9%) 24 (17.6%) 2 (1.5%) 1 (0.7%) 136 (100%) 2016 1 (0.7%) 5 (3.4%) 122 (84.1%) 15 (10.3%) 2 (1.4%) 0 145 (100%) 2017 1 (0.5%) 12 (6.5%) 149 (80.1%) 20 (10.8%) 0 4 (2.2%) 186 (100%) Lectures 2015 0 7 (5.1%) 114 (83.8%) 14 (10.3%) 0 1 (0.7%) 136 (100%) 2016 0 8 (5.5%) 119 (82.1%) 15 (10.3%) 3 (2.1%) 0 145 (100%) 2017 0 16 (8.6%) 146 (78.5%) 20 (10.8%) 0 4 (2.2%) 186 (100%) Practices 2015 1 (0.7%) 5 (3.7%) 121 (89.0%) 5 (3.7%) 0 4 (2.9%) 136 (100%) 2016 0 6 (4.1%) 123 (84.8%) 6 (4.1%) 4 (2.8%) 6 (4.1%) 145 (100%) 2017 0 13 (7.0%) 147 (79.0%) 8 (4.3%) 1 (0.5%) 17 (9.1%) 186 (100%) - 278 -
엄태현외 : 의료기관혈액원실무자혈액관리업무교육프로그램평가 짧다 는응답은각각 5.1% 8.6%, 3.7% 7.0% 였다 (Table 5). 2) 교육횟수교육횟수로서 1년에 1회시행이적당하다 는응답이 53.8% 69.1% 로서가장많았고, 1년에 2 회, 2년에 1회 가각각 25.7% 40.0%, 1.6% 3.7% 였다 (Table 6). 3) 교육실시시기교육실시시기로서 1분기가적당하다 는응답이 23.4% 53.8%, 2분기가 40.3% 61.4% 였으며, 3분기 2.2% 8.8%, 4분기 0% 4.1% 였다 (Table 7). 고찰의료기관혈액원담당자를위한질병관리본부와혈액안전사업단의교육프로그램은매년유사한주제로진행되었다. 프로그램은 1일교육으로서강의와실습으로구성되는데, 2017년에는강의교육으로서질병관리본부담당자의혈액관리업무심사평가체계및전년도혈액관리업무심 사평가결과와해당년도심사평가계획에대한안내, 수혈의학전공교수들의혈액형검사최신지견, 혈액제제품질관리, 환자혈액관리 (patient blood management, PBM) 에대한강의, 그리고대한적십자사혈액원의무관리실장의헌혈관련증상과헌혈자보호및안전에대한내용으로구성되었다. 실습교육은대한적십자사간호팀담당자가헌혈자문진및채혈과정에대해설명하고실습을지도하였다 (Table 8). 교육내용에대한만족도로서설문조사응답자의 86.1% 88.2% 가 매우만족 또는 만족 한다고응답하고있으며, 교육필요성에대해서는 88.9% 94.7% 가 매우필요 또는 필요 하다고응답하고있다. 의료기관혈액원종사자와국방부소속피교육자를구분하여분석한 2017년결과를보면, 교육내용만족도에서각각 91.0%, 82.8%, 교육필요성에서각각 96.7%, 90.6% 로서의료기관혈액원종사자의만족도가더높았다. 국방부소속피교육자의만족도와필요성인식정도가상대적으로낮게나타나기는하였으나본 Table 6. The appropriate number of training program perceived by survey respondents Year Biannual Annual Biennial Others No-response Total 2015 35 (25.7%) 94 (69.1%) 5 (3.7%) 1 (0.7%) 1 (0.7%) 136 (100%) 2016 58 (40.0%) 78 (53.8%) 3 (2.1%) 0 6 (4.1%) 145 (100%) 2017 64 (34.4%) 116 (62.4%) 3 (1.6%) 0 3 (1.6%) 186 (100%) Table 7. The appropriate quarter of the year for training program perceived by survey respondents Year Quarter 1 Quarter 2 Quarter 3 Quarter 4 No-response Total 2015 67 (49.3%) 58 (42.6%) 12 (8.8%) 2 (1.5%) 4 (2.9%) 136/143* 2016 34 (23.4%) 89 (61.4%) 11 (7.6%) 6 (4.1%) 8 (5.5%) 145/148* 2017 100 (53.8%) 75 (40.3%) 4 (2.2%) 0 4 (2.2%) 186 *Number of responses with multiple responses allowed. - 279 -
Korean J Blood Transfus Vol. 28, No. 3, 275-281, Dec. 2017 Table 8. Schedule of education program for blood managements in 2017 Time Topic Lecturer 9:20 9:40 Registration 9:40 9:50 Opening 9:50 10:10 The Results of Evaluation for Blood management Korea Centers for Disease Control and Prevention in 2016 and Plan in 2017 10:10 10:40 Updates on ABO, RhD blood typing Professor 10:40 11:10 Quality Control of Blood Products Professor 11:10 11:30 Questions and Answers, Coffee break 11:30 12:00 Patient blood management and blood bank Professor 12:00 12:30 Donation related symptoms and Protection for Medical Director of Korean Red Cross Donor safety 12:30 14:00 Lunch 14:00 14:10 Donation procedure, Blood product preparation and Nursing department of Korean Red Cross supply (Movie) 14:10 14:40 Donor interview and Donation procedure (Lecture) Nursing department of Korean Red Cross 14:40 15:00 Discussion and Questionnaire survey Korean Red Cross Korea Centers for Disease Control and Prevention 15:00 17:00 Trip to donation center Korean Red Cross 교육의원래목표대상이의료기관혈액원종사자인만큼, 교육목표에제대로부합하고있는것으로보인다. 따라서새로운정보를반영하는업데이트는매년하여야하겠으나당분간은교육주제를크게변화시킬필요는작은것으로생각된다. 프로그램운영과관련한사항으로서교육시간에대해 1일이적당하다는응답이 77.9% 84.1% 로가장많았고, 길거나짧다는응답은모두 10% 미만에불과하였다. 현재시행하는 1일간의교육시간은적당한것으로생각된다. 교육횟수는현재와같이 1년에 1회시행 이적당하다는응답이가장많았으나 1년에 2회 가적당하다는응답도 25.7% 40.0% 에달하였다. 현재전국에소재한 7개의적십자사혈액원에서교육을제공하고있고, 교육장소에있어지역적인제한을두지않고있기는하지만 3월또는 4월에거의매일연속적으 로시행하였기때문에참석에어려움을느끼는경우도있는것으로생각이된다. 본교육이혈액관리업무심사평가에대비하는의료기관혈액원들을돕기위한목적도있으므로가능한 1분기에실시하는것이바람직하지만, 피교육자의편의를위하여 2분기추가교육도고려해보아야할것으로보인다. 관련된문항인적당한교육실시시기에대한문항에서도 1분기와 2분기가약 50% 정도로유사하였음은주시할만하다. 기타조사내용으로개별강의에대한평가, 현장실습의적절성, 교육장소, 프로그램진행에대한만족도문항들도있었고, 응답자의의견을직접서술하는문항도있었다. 개별강의에대한평가는프로그램보다는개별강사에대한평가측면이큰것이므로본연구에서는언급하지않았다. 교육장소나프로그램진행에대한평가도동일한이유로언급하지않았다. 물론구체적인 - 280 -
엄태현외 : 의료기관혈액원실무자혈액관리업무교육프로그램평가 프로그램을계획할때에는반드시고려해야하는요소들인것은분명하다. 본연구의한계점은설문조사대상에의료기관혈액원종사자뿐아니라일부공급혈액원종사자와국방부소속피교육자도포함되었으며구분하여분석하지못하였다는점이다. 2017년설문조사에서는답변자의소속을구분하여분석할수있었으나 2015년과 2016년조사는구분하지못하였기때문이다. 결론적으로본교육프로그램은의료기관혈액원혈액관리업무담당자들의필요를충족하는유용한교육의역할을수행하고있는것으로생각된다. 규모가크고채혈량이많은대한적십자사혈액원, 대한산업보건협회부설한마음혈액원및중앙대학교병원혈액원과같은공급혈액원은혈액관리업무에대한자체적인교육시스템을갖출수있겠으나채혈량이적거나거의없는의료기관혈액원에서는자체적인교육시스템을갖출여건이되지못하는경우가많기때문일것이다 [5]. 설문조사등을통해제안되는개선요구사항들을지속적으로보완해가며더욱유용한교육프로그램으로발전시켜야할것으로생각된다. 요약배경 : 질병관리본부는 2013년부터매년의료기관혈액원혈액관리업무담당자를위해 1일간진행하는교육프로그램을전국적으로운영해오고있다. 설문조사를통해프로그램의목표달성도를평가하고향후개선방안을제안하고자하였다. 방법 : 2015년부터 2017년까지교육실시직후설문조사를실시하였다. 조사항목은응답자의소속기관및직종, 교육내용에대한사항, 프로그램운영에대한사항등으로구성하였다. 결과 : 설문조사응답률은 56.2% 73.2% 였다. 응 답자의직종은임상병리사 66.9% 75.7%, 간호사 16.1% 22.1%, 기타 ( 행정직등 ) 1.5% 11.3% 였다. 전반적인교육내용에 매우만족 또는 만족 한다는응답이 86.1% 88.2% 였으며, 교육이 매우필요 또는 필요 하다는응답이 88.9% 94.7% 였다. 프로그램시간은 1일이적당하다는응답이 77.9% 84.1% 였으며, 교육횟수는 1년에 1회시행이적당하다는응답이 53.8% 69.1% 로서가장많았다. 교육실시시기는 1분기또는 2 분기가적당하다는응답이각각 23.4% 53.8%, 40.3% 61.4% 였다. 결론 : 질병관리본부교육프로그램은의료기관혈액원혈액관리업무담당자들을위한유용한교육의역할을수행하고있는것으로생각된다. References 1. Shin JW, Park R, Choi TY, Park KI, Kim HO. Analysis of present status as blood donation center of hospital blood banks and satisfaction level with the Korean Red Cross. Korean J Blood Transfus 2004;15:168-78 2. Korean Red Cross. Blood services statistics 2015. Wonju: Korean Red Cross, 2015 3. Choi GR, Kim HO, Kim S, Jang CH, Choi YS, Kim JN. Analysis survey on changes in hospital blood donation center and satisfaction level with the Korean Red Cross. Korean J Blood Transfus 2015;26:142-51 4. Kim HO. Final report, Korea blood safety project 2015. Osong: Korea Centers for Disease Control and Prevention, 2016 5. Lim HS, Lim CS, Cha YJ, Choi YY, Lim YA, Suh JS. Inspection of blood collection center with small number of unit collection. Korean J Blood Transfus 2009;20:195-200 - 281 -