提升急診病人侵入性檢查作業完整率之改善專案

Improving the Process of Completing Invasive Procedures in the Emergency Department

簡杏津(Hsing-Chin Chien) ； 陳秀分(Hsiu-Fen Chen) ； 黃惠美(Hui-Mei Huang)

《榮總護理》 26卷4期 (2009/12) Pp. 357-366

https://doi.org/10.6142/VGHN.26.4.357

摘要

急診病人常因病況需要接受侵入性檢查，但大部份的檢查是無排程，且缺乏充分時間說明及準備，很容易導致家屬及病人焦慮，引發醫療糾紛與危及病人安全。於2007年1月收集本院急診病人接受侵入性檢查作業之完整率為42%，主要原因包括：檢查同意書填寫不完整、病人辨識不確實、衛教內容不一致、檢查前後生命徵象未測量及醫療人員聯繫未確實等問題。經由團隊合作擬定改善措施為：由資訊室協助侵入性檢查同意書電腦化、制定及修訂衛教單張內容並電腦化、製作多媒體衛教光碟及在職教育等改善方案，讓急診病人接受侵入性檢查作業之完整率提高至96%。專案結果不但提升急診病人侵入性檢查的安全，護理人員可以使用簡單易懂的多媒體影像向病人解釋檢查的過程，電腦化同意書也減少護理人員一再重複書寫檢查同意書的項目及內容，避免錯誤書寫，提高護理效益。

關鍵字

侵入性檢查 ； 病人安全 ； 同意書電腦化

並列摘要

Most patients receive some kind of invasive procedures in the emergency department. Since the invasive procedures in emergencies are urgent, they are sometimes done with insufficient interpretation and inadequate time to prepare. Patients and their families become anxious due to their lack of knowledge about the impending invasive procedure. Such rushed situations compromise safety and can lead to adverse outcomes. After investigating one emergency department in January 2007, the most common causes for the incompleteness of invasive procedures were (1) incomplete consent forms, (2) lack of patient identification, (3) inconsistent interpretation for an invasive procedure, (4) monitor problems, and (5) poor communication. In this task force, we set up a computerized consent form, a review and renewal of related education papers, which we computerized, and took video of the invasive procedure for staff training courses. After implementation, the emergency department staff improved their performances. Our results showed the rate of completing invasive procedures before and after implementation to be 42% and 96% respectively.

並列關鍵字

invasive procedure ； patient safety ； computerized informed consent from received