應用ISO標準流程作醫院工作環境之調查、研究及改善，已持續改善醫療品質

Improvement in Quality of Healthcare by Applying ISO to Hospital Work Environment

白佳原(Jar-Yuan Pai) ； 游士嫺(Shih-Hsien Yu) ； 曾馨慧(Sin-Huei Zeng) ； 賴麗娜(Li-Na Lai) ； 黃冠凱(Kuan-Kai Huang) ； 謝仁棟(Jen-Tung Hsieh)

《中山醫學雜誌》 19卷2期 (2008/12) Pp. 175-185

https://doi.org/10.30096/CSMJ.200812.0004

摘要

背景：本研究藉由ISO 6.3基礎設施及6.4工作環境對樣本醫院進行盤點及量測分析；ISO 7.6監控與量測儀器的管制提供更可靠及更具符合品質標準儀器設備。
材料與方法：至樣本醫院各單位裝置高效率微粒空氣過濾器(High Efficiency Particulate Air, HEPA)及無HEPA裝置區域，量測0.5μm cumulative之懸浮微粒。量測區域：(1)醫療單位：開刀房、加護病房、恢復室、中央供應室；(2)醫療照護區域：病房、急診室、檢驗科、門診、洗腎室；(3)院內單位：管理部、人事處；透過深度訪談及稽核各部門、建立符合ISO品質管理系統環境清潔作業指導書；透過PDCA管理循環，建立全面品質管理；採用系統動態學詮釋品質政策及品質目標對醫療環境基礎設施及工作環境之影響。
結果：量測裝置HEPA區域結果發現，16間開刀房中有5間不符合標準；4個加護病房皆超過標準值；硬體設施，例如：(1)管理部環境未定期清潔；(2)緊急照明燈，出口標示燈及避難方向指示燈照明時間未符合消防法之規定；(3)空調設備未定期清潔；(4)醫療儀器未定期校正。
結論：環境及設施參照ISO 8.5持續改善，針對不符合標準區域，例如：開刀房、加護病房溫度及濕度必須符合美國醫院評鑑協會標準、加強檢驗及保養空氣過濾器。空調設備必須定期清潔；透過系統動態學因果關係圖可以清楚提供醫院擬定政策時更具宏觀、系統性思考。

關鍵字

ISO ； 基礎設施 ； 工作環境 ； 品質 ； 醫院 ； 系統動態學

並列摘要

Background: To find out whether control, monitoring, and measurement (ISO 7.6) can provide more and corresponding better quality use of hospital instruments and equipment, our team reviewed and measured infrastructure (ISO 6.3) and work environment (ISO 6.4) in one hospital.
Material and Methods: We measured and reviewed the airborne particles above 0.5 micrometers (μm) in diameter in units with and without high efficiency particulate air (HEPA). The units were categorized into three groups: Gr. 1, operating room (OR) intensive care unit (ICU), recovery room, and central supply room (CSR); Gr. 2, wards, emergency room (ER), laboratory, outpatient patient Department (OPD) and hemodialysis unit; and Gr. 3, administration department and human resource department. Environmental cleaning procedures were proposed and listed as audit requirement for ISO quality management system after careful audits and conducting in-depth interviews with each unit director. In addition to using PDCA (plan, do, check and action) management cycle to build total quality management system, we adapted System Dynamic (S.D.) to simulate quality policy and quality objectives to influence the medical environment and working environment.
Results: (1) Five out of 14 ORs and 4 ICU units did not meet the requirement of standard. (2)The environment of administration department was not cleaned regularly. (3)The lighting times for emergency light, exit lights and escape lights did not correspond to fire control regulations. (4)The filters of air conditioning units were not routinely cleaned. (5)The medical instruments were not been adjusted periodically.
Conclusions: Using the concept of continued improvement (ISO 8.5), the hospital regularly checked and corrected all units that did not conform to AHA (American Hospital Association) standards. Also using System Dynamics causality chart, hospital decision making policy more macroscopic and systematic.

並列關鍵字

ISO ； infrastructure ； work environment ； quality ； hospital ； system ； Dynamic