下列哪種情況明確需要在醫院建立正式異常事件通報單，專門留存於品質管理紀錄中？
Which situation explicitly necessitates completing a formal hospital incident report strictly for quality management records?
- AA newly admitted severely agitated psychiatric client loudly shouts profanities at the television safely in his secure room.一名新入院的精神科嚴重激躁病人在其安全房間內對著電視大聲辱罵。
- BA visitor quietly slips on a freshly mopped wet floor in the hallway, miraculously catching themselves without physical injury.✓ 正解一名訪客在走廊剛拖過的濕地板上悄悄滑倒，奇蹟般地自行撐住而未受身體傷害。
- CAn advanced stage cancer client formally actively refuses their morning scheduled dose of pain medication entirely.一名晚期癌症病人正式主動完全拒絕早晨預定的止痛藥物劑量。
- DThe physician decides to suddenly deeply change the client’s scheduled surgery from Monday to Tuesday purely for scheduling reasons.醫師純粹基於排程理由，決定突然將病人的預定手術從週一改到週二。
本題測驗異常通報單 (Incident report) 的啟動時機。通報單不是用來舉報犯罪，而是醫院內部防範「環境安全/系統失誤」的檢討工具。遇到『跌倒、給錯藥、漏給藥、機器故障、醫護被針扎、哪怕是「差點跌倒但沒受傷 (near-miss)」』，都『必須』填寫異常通報單。選項 B 的訪客滑倒即使沒事，也代表地板清潔程序的警示標誌系統 (Wet floor sign) 失效，這是一個潛在的風險，必須通報以改進環境安全。選項 C (合法拒絕吃藥)、選項 D (醫師改時間)、選項 A (精神病患發瘋大叫) 都屬正常臨床狀態，不用寫通報單。
This question tests the indications for completing an incident report. Incident reports are not used to report crimes but are an internal hospital tool for reviewing environmental safety or systemic errors. Events such as falls, medication errors, missed doses, equipment malfunction, needle-stick injuries, or even near-misses (almost falling without injury) all require an incident report. In option B, even though the visitor was uninjured, the slip indicates that the wet floor sign warning system failed, representing a potential hazard that must be reported to improve environmental safety. Options A (legal refusal of medication), D (physician schedule change), and A (psychiatric patient yelling) all represent normal clinical situations not requiring an incident report.
Near-miss (跡近錯失/虛驚事件)。就算沒人受傷，只要有跌倒或給錯藥的風險發生過，就一定要抓出來通報檢討，這點美台評鑑標準完全相同。