提升護理作業運作改善恢復室停留時間延長比率專案

手術病人停留恢復室大於兩小時比率是台灣臨床成效手術照護指標之一，恢復室停留時間延長會影響手術作業流程。本單位手術病人停留恢復室大於兩小時比率為8.26％，故而引發本單位進行專案深度探討。調查中發現護理作業因素造成停留延長不良率2.61％，佔所有不良率百分比31.6％，經查檢發現尖峰時段超時平均時間為150.8分，佔負荷超載總比率的79.2％，且尖峰時段人床比偏高；經病歷查檢發現於病人進入恢復室43.4分鐘開始處理疼痛，平均處理疼痛需花費36.8分鐘，花費恢復室照護時間38.6％；實際查驗護理師在點選延遲轉出原因時，勾選病人病情欠穩，但於紀錄及給藥中未發現特殊處置及生命徵象穩定，且超時時間非人力尖峰時段；原因為負荷超載、處理疼痛、無延遲提醒。經專案小組擬定改善方案：一、分組/夜班工作規範；二、生理監視器碼表功能；三、麻醉記錄連動麻醉動態管理系統；四、安排麻醉前衛教提供選擇神經阻斷止痛衛教等。結果顯示恢復室停留大於2小時比率自8.26％降至1.25％，護理作業造成停留延長不良率由2.61％降至0.12％，改善幅度95.4％，期能藉提升護理作業，減少病人在恢復室停留時間，能返回病室及早復原。

關鍵字

恢復室；停留；台灣臨床成效；超時；護理作業

並列摘要

Surgical patients' stay in the recovery room for more than 2 hours is a critical indicator of surgical care in the Taiwan Clinical Performance Indicator. If the recovery room is fully occupied, surgical patients frequently wait in the operating room after awakening from anesthesia. In our hospital, the proportion of patients staying in the recovery room for more than 2 hours was 8.26%. Accordingly, this study comprehensively examined the causes of this prolonged stay. An assessment of the incidence of prolonged patient stay in the recovery room revealed that 2.61% of the prolonged stay was due to nursing shortcomings, which accounted for 31.6% of shortcomings in 2019. The average prolonged stay time during peak hours was 150.8 minutes, constituting 79.2% of the total overload rate; nevertheless, during peak hours, nurse-patient ratios were high. Medical records showed that on average, pain was addressed 43.4 minutes after patient entry into the recovery room and was resolved 36.8 minutes after treatment (38.6% of available nursing time). Nurses classified patients' conditions as unstable when selecting reasons for delayed transfer out, but no special treatment or vital sign problems were found in patient records, indicating that patients were not unstable, and no indication of workforce overload existed. In summary, this study demonstrated that surgical patients' prolonged stay in the recovery room were due to workforce overload, pain management, and lack of notification of prolonged stay. Accordingly, to address this problem, this study proposed the following improvement measures: (1) reallocation of nurse shifts, (2) provision of stopwatch reminders for physiological monitoring, (3) use of a real-time dynamic display board, and (4) provision of an appropriate choice of nerve blocks during preanesthesia preparation. After the implementation of these measures, the incidence of prolonged stay in the recovery room decreased from 8.26% to 1.25%. The rate of prolonged stay due to nursing shortcomings decreased from 2.61% to 0.12%, indicating a 95.4% improvement rate. By sharing this experience, we aim to improve nursing manipulation and reduce prolonged patient stay in the recovery room.

並列關鍵字

recovery room ； prolonged stay ； Taiwan Clinical Performance Indicator ； overtime ； nursing manipulation

參考文獻

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