應用APACHE SCORE 於加護病房護理行政業務之探討

The Applicability of APACHE Scoring System for ICU Patient Management and Nursing Staffing

邱艷芬(Yann-Fen C. Chao)

《慈濟醫學雜誌》 7卷3期 (1995/09) Pp. 187-193

https://doi.org/10.6440/TZUCMJ.199509.0187

摘要

本研究的目的在探討以APACHE(Acute physiological and chronic health evaluation system)評量得分(APACHE Score)作為病人分類的可行性，以及以APACHE score分配護理人力，以改善加護病房護理人員之排班方式之可行性與效果。計有區域教學醫院加護病房病患提供4245筆資料，醫學中心內外科加護病房病人提供477筆資料作為統計分析。研究結果顯示：住入MICU的病人比住進SICU者，其平均APACHE得分較高，且具有統計上意義，反映出MICU病人病情較SICU病人嚴重；而自加護病房轉出的病人中，其APACHE分數顯示死亡率高達三成；醫學中心的病人一般均較區域醫院者有較高之APACHE得分，病情較為嚴重，其中病人停留ICU期間與病人轉出ICU的差異具有統計上之意義。這些結果說明了在病情嚴重程度的反映上，APACHE分數提供相當可信的參考數據，可以作為病人分類的基準，也可以作為護理人力配置與工作指派的依據，研究者更建議以APACHE分數作為病人轉入、轉出加護病房的參考，以確保加護病房之醫療效率，保障病人之安全。本研究提出兩種以APACHE分數作為參考數據的加護病房病人分類方式，與三種護理人力配置與工作指派標準，供醫療行政與加護單位主管人員選用。

關鍵字

加護病房 ； 疾病嚴重度 ； 病人分類 ； 人力配置

並列摘要

The purpose of this study was to investigate the applicability of APACHE scoring system for patient classification, patient assignment and nursing staffing of ICUs. A total number of 4722 sets of data were obtained from one medical center in Taipei area and one local teaching hospital in Hualien for data analysis. The results showed that MICU patients had higher APACHE scores (more severe) than SICU ones; a lot of patients were transferred out from ICUs with high risk of death as indicating by APACHE scores; the patients in the ICU of medical center had higher APACHE scores than than those in the ICUs of local teaching hospital. These results demonstrated that the APACHE score is a valid indicator reflecting patients’ needs of medical and nursing care and is applicable for ICU patient classification, patient assignment and nursing staffing. Two ways of applying APACHE score to classify ICU patients and three methods of using APACHE score for patient assignment and nursing staffing were also proposed and evaluated.

並列關鍵字

ICU ； patient classification ； severity of illness ； patient assignment ； staffing