精實思想管理以傷口照護流程為例

精實管理源於工業管理，主要應用在流程上的改善，目的是爲了降低浪費與減少錯誤，進而有效提升生產效能與降低成本。近年也被引用於健康照護機構流程上的改善，對醫療產業而言降低錯誤的風險管理，不但可以維護病人安全，同時也能提升照護品質。精實管理中價值溪流分析可以找出浪費的根源，排除不必要的動作，加強流程的正確性。本文介紹中部某醫學中心，應用精實管理(Lean Thinking Management)於傷口照護建置流程。臨床上傷口種類多樣，由於造成原因不同而有不同的專業評估與措施，加入資訊化決策系統後，能更有效的改善傷口照護，將多餘的時間做臨床照護病人的工作。本院建置壓傷照護流程，是應用精實管理中價值溪流分析配合自働化(Jidoka)，結果在時間上減少護理人員文書及電腦操作時間約40分鐘，但未降低在病人床旁傷口照護時間。此外，1級壓傷的評估結果，原來僅佔所有評估爲壓傷的30%提升至近60% ，表示能及時篩檢初期壓傷，提前給予病人相關措施。

關鍵字

精實管理；壓傷；傷口照護

並列摘要

Lean Thinking Management originated from industrial management, used to improve the production process with the purpose of reducing resource waste and errors so as to effectively improve the production efficiency and reduce costs. In recent years, it has also been used to improve healthcare institutions, specifically to reduce risks and increase the quality of care. Using the Value Stream Analysis, we can look for the root causes of waste, eliminate unnecessary actions and enhance the accuracy of the processes There are many kinds of wounds seen and treated in the hospital with specific assessments to identify the necessary steps of treatment. By employing digitalized and professionally designed assessment tools, clinical nurses can effectively and efficiently deliver care for patients, allowing for an increase in productivity. Our hospital utilized lean thinking management to create a care routine for pressure injuries by conducting a value stream analysis. As a result, the time needed for nurses to record and operate computers was reduced by approximately 40 minutes. However, though the time used to operate machinery was reduced, the nurses were unable to reduce the time spent on bedside wound care. In addition, there was an increase in Grade 1 pressure injuries from 30% to 60%, showing a need for an improved and more efficient screening process in the initial stages of wound detection.