提升外傷科護理人員重症評估照護處置完整率

Improving the Complete Rate of Trauma Nursing Staff's Critical Care Assessment and Management

沈欣慧(Hsin-Hui Shen) ； 郭貞嬋(Chen-Chan Kuo) ； 邱存梅(Tsun-Mei Chiu) ； 鄭喬尹(Chiao-Yin Cheng) ； 謝昱嫻(Yu-Hsien Hsieh)

《新臺北護理期刊》 23卷1期 (2021/03) Pp. 77-89

https://doi.org/10.6540/NTJN.202103_23(1).0008

摘要

外傷科病人為特性多變性與高複雜性，護理人員應具備專業重症評估照護能力，即早介入評估處置，避免非預期性心跳停止事件發生。2017年非預期性心跳停止事件5件，死亡率高達80.0%；分析問題為護理人員對重症評估照護處置完整性僅達63.0％、重症評估照護認知正確率僅達71.8%；解決辦法為建立「外傷科臨床通報流程」、運用「外傷科重症評估照護多媒體教案」、舉辦「急救擬真情境演練競賽」，設計「重症評估工具-紅綠燈警示圖」與「小惡魔呼吸卡」提示牌；專案結果護理人員重症評估照護處置完整率提升至93.5%，重症評估照護認知正確率提升至94.1%，執行12個月可有效降低非預期性心跳停止事件至2件，建議臨床應增加簡易呼吸照護評估工具，提升專科護理照護品質。

關鍵字

重症評估 ； 團隊資源 ； 照護處置

並列摘要

The characteristics of traumatic patients are variable and highly complex. Therefore, nursing staff must have professional critical assessment and care ability and early intervention in assessment and treatment to avoid unintended cardiac arrest events. In 2017, there were 5 unanticipated cardiac arrest events with a mortality rate of 80%. The main problem was that the traumatology care nursing staff had only 63.0% complete treatment for critically assessed care, and the correct rate of care for nursing staff was only 71.8%. The solution was to establish a ＂Clinical Notification Process for Trauma＂, use the ＂Disciplinary Critical Care Assessment Multimedia Teaching Plan＂, and host the ＂First Aid Situational Exercise＂, and design ＂Severe Assessment Tool - Traffic Light Warning Map＂ and ＂Little Devil Breathing Card＂ prompt card. Results of the project in the critical assessment of the care in the nursing staff increased to 93.5%. The critical assessment of nursing awareness increased to 94.1%. The implementation of 12 months effectively reduced the number of unexpected cardiac arrest events to 2. It is recommended that a simple respiratory care assessment tool should be added to improve the quality of specialist care.

並列關鍵字

critical care assessment ； team resource management ； care management

參考文獻

江金英、賀倫惠、莊月娥、謝錦榕、龔秀玲（2017）。跨團隊合作降低心臟內科病人非預期心跳停止急救的發生率改善專案。醫務管理期刊，18（1），73-87。https://doi.org/10.6174/JHM2017.18（1）.73。

江以薰、吳麗玉（2012）。照顧一位肺挫傷合併血氣胸病人之護理經驗。高雄護理雜誌，29（2），83-94。https://doi.org/10.6692/KJN-2012-29-2-8。

邱俊仁、徐國基、吳鋼治、邱浩彰、楊國卿、侯勝茂、廖熏香（2014）。以醫療品質突破系列提升院內心跳停止事件急救之照護品質。台灣醫學，18（2），226-237。https://doi.org/10.6320/FJM.2014.18（2）.13。

邵上智、蔡明翰、蔡培癸、劉雪娥（2015）。多媒體衛教光碟合併護理指導對於初次冠心病患者在疾病知識、態度及自我照顧行為之成效探討。護理暨健康照護研究，11（3），175-186。https://doi.org/10.6225/JNHR.11.3.175。

郭書麟、鄭嘉惠、卓淑玲、洪聖、王拔群（2014）。急重症高擬真模擬情境團隊訓練成效初探。輔仁醫學期刊，12（2），89-96。https://doi.org/10.3966/181020932014061202002。