医療安全におけるノンテクニカルスキル重視の歴史と現状

Current Studies on Non-technical Skills for Patient Safety

はじめに

　患者安全（patient safety）という概念は，1985年に設立された米国の麻酔患者安全財団（The Anesthesia Patient Safety Foundation：APSF）によって提示されたことから始まり，航空分野など高リスク産業の成果を取り入れられつつ発展してきた。米国国防総省（Department of Defense：DoD）と医療の質研究庁（Agency for Healthcare Research and Quality：AHRQ）により開発された，チーム訓練法のTeamSTEPPS^®も，すでに四半世紀以上の歴史を持ち，世界中に展開されている。本論文では，ノンテクニカルスキルが臨床現場でどのように応用されうるかの現状を概観する。

　In the Anaesthetists’ Non-Technical Skills（ANTS）System, leadership is incorporated into the team working category, as there are times when the anesthesiologist may lead the OR team. Between 1990 and 2018, there are 76 published tools for the measurement of NTS in healthcare across seven clinical areas with widely differing methods of scoring for either individuals or teams. The methods of development and rigour of assessments of validity varies widely amongst these tools. Recommendations for training also vary greatly and pragmatic assessment of usability is scarce. The ideal tool for NTS assessment in healthcare does not yet exist. During the COVID-19 pandemic, NTSs have been considered crucial in defning situation awareness, enhancing decision making, communicating among groups and teams, and fostering leadership. In order to nurture the psychological safety, team leaders should demonstrate engagement, show understanding, be inclusive in interpersonal settings, be inclusive in decision-making, and show confidence and conviction without appearing inflexible.