運用團隊資源管理提升大腸直腸癌首次化學治療病人出院服務滿意度

Applying team resource management to improve the satisfaction of discharge service among patients with colorectal cancer receiving first chemotherapy

沈心薇(Hsin-Wei Shen) ； 洪婉綺(Wan-Chi Hung) ； 張素容(Su-Jung Chang) ； 高綺吟(Chi-Yin Kao)

《高雄護理雜誌》 36卷3期 (2019/12) Pp. 28-41

https://doi.org/10.6692/KJN.201912_36(3).0003

摘要

出院服務滿意度為醫療照護品質的評估指標之一，本單位大腸直腸癌首次化學治療病人出院服務滿意度為2.9分（1－5分），且2015年上半年14天內再入院率為14.7%。經調查確認問題為病人住院期間的心理情緒未獲支持、藥物與飲食未獲合適指導以及返家後缺乏副作用自我處理照顧能力。上述原因顯示病人住院期間缺乏護理師、藥師、心理師以及營養師等團隊整合照護模式的共同照護。專案目的為提升大腸直腸癌首次化學治療病人出院服務滿意度至4分。運用團隊資源管理擬定解決策略，包括單位主負責護理師負責電訪與協助電話諮詢、衛教內容標準化、設置藥師、腫瘤心理師與營養師之照會與預警機制、建立單位化療相關護理指導之品管指標監測。結果呈現2017年大腸直腸癌首次化療病人接受護理指導達成率為95%；化療相關藥物護理指導執行率及回覆示教正確率分別為99%及97%；2015年出院後14天再入院率由14.7%降至2017年0%，2015年出院服務滿意度由2.9分提升至2017年4.2分。透過跨團隊合作可提高照護品質，進而改善大腸直腸癌首次化學治療病人出院服務滿意度。

關鍵字

首次化學治療 ； 大腸直腸癌 ； 團隊資源管理 ； 滿意度

並列摘要

Patient satisfaction with discharge service is one of the indicators regarding quality of care. The score of satisfaction with discharge service was 2.9 (Likert scale 1-5) and the readmission rate was 14.7% among patients with colorectal cancer receiving first chemotherapy in the first six months of 2015. After investigation, the reasons of patient poor satisfaction included lack of emotional support, medication and diet consultations, and self-care ability regarding side effects. This demonstrated that a multidisciplinary team approach was needed during hospitalization. The aim of the project was to improve the satisfaction score of discharge service from 2.9 to 4 (Likert scale 1-5) among patients with colorectal cancer receiving first-time chemotherapy. Team resource management was applied to develop several strategies. These included the leader being responsible for telephone visits and consultations; the content of patient education was standardized; an e-consultation and early warning mechanism for pharmacists, psychologists and dietitians was set up; and patient education was established to monitor indicators of quality control. Results in 2017 showed that the nursing education rate was 95%; chemotherapy education rate was 99% and the teach-back rate of chemotherapy was 97%; readmission rate was 0%; and the score of satisfaction with discharge service improved from 2.9 to 4.2 among patients with colorectal cancer receiving first chemotherapy. The project indicated a multidisciplinary team approach could improve satisfaction with discharging services and then improve the quality of care.

並列關鍵字

Chemotherapy ； colorectal cancer ； team resource management ； satisfaction

參考文獻

洪欣妏、蕭宇伶、楊玫蓉、劉中賢、陳誠仁、嚴元鴻(2011)．導入醫療團隊資源管理(TRM)對提升醫療品質效應初探-以某區域醫院住院病人滿意度為例．醫療品質雜誌，5(3)，48-56。doi:10.30160/ JHQ.201105.0010

姚遠賢、謝東呈、蘇淑芬、王守玉(2011)．現今大腸癌之治療趨勢．弘光學報，65，72-92。doi:10.6615/ HAR.201112.65.06

連金延、陳淑慧、蔡佩嬪、陳康敏、謝雅宜、梁穎(2010)．首次接受化學治療乳癌婦女介入護理指導後不確定感、焦慮及自我照顧之成效探討．護理雜誌，57(6)，51-60。doi:10.6224/JN.57.6.51

陳仁惠、鄭仲興、方世杰(2005)．門診醫療服務品質與病患滿意度對於關係導向行為之影響．醫護科技學刊，7(2)，187-202。doi:10.6563/ TJHS.2005.7(2).7

陳淑芬、林怡孜、蔡麗雲(2008)．提升腫瘤病房住院病人護理服務滿意度方案．馬偕護理雜誌，2(1)，27-36。doi:10.29415/JMKN.200801_2(1).0003