醫療團隊資源管理－流程確認單於放射腫瘤治療部門之應用

Team Resource Management - The Patient Hand-off Check List (PHCL) Application on Radiation Oncology

黃淑香(Shu-Hsiang Huang) ； 范佩華(Pei-Hua Fan) ； 翁麗慧(Li-Hui Weng) ； 梁為民(Wai-Man Leung) ； 陳彥超(Yen-Chao Chen)

《中華放射線技術學雜誌》 40卷3期 (2016/09) Pp. 123-129

摘要

為給予病人更安全及高品質的醫療照護。故依循團隊資源管理（team resource management, TRM）之精神與ISBAR (identify/situation/background/assessment/recommendation)手法設計出適合本科使用的流程確認單（patient hand-off check list, PHCL），使交班流程能順暢及達到確實的交班。從民國101年10月開始實施，統計至民國104年6月各組PHCL完成度之結果：醫師護理組由102年1~3月71.1%提升為104年4~6月的90.8%；醫事放射師組部分由101年10~12月96.7%提升至104年4~6月的99.6%；物理組部分由101年10~12月的98.3%提升為104年4~6月的99.1%。再由TRM課程出席率看來，102年8月起上課出席率達100%，相對101年10~12月到102年10~12月各組PHCL平均完成度結果：醫師護理組由95.5%提升至98.8%；醫事放射師組由98.3%提高至99.1%；物理師組則是99.6%至99.7%。經由確實的教育訓練、良好的表單設計、將流程確認單夾放至首頁、多方察閱及增進同仁健康身心等分法，讓流程確認單能確實完成。更也改善以往將交班事項黏貼在病歷封面的缺點，同時亦可作為新進員工教育訓練之學習重點。而透由流程確認單完成率之監測，可從中發現作業流程不盡完善的部分，便可透由加強工作訓練來精進或檢討工作流程來修正。

關鍵字

團隊資源管理（TRM） ； 流程確認單（PHCL） ； ISBAR

並列摘要

A patient hand-off check list (PHCL) is designed using team resource management (TRM) and ISBAR (identify/situation/background/assessment/recommendation) method, in hope to make the hand-off procedure more fluent and without error. We computed the completion rate of the PHCL item by item, and its relation to staff/TRM training hours. Our RTO department started using PHCL from October 2012 and analyzed in July 2015. Since 2012, the completion rate has risen from 71.1% to 90.8% for physician/nurse PHCL, 96.7% to 99.6% for radiological technologist and 98.3% to 99.1% for radiological physicist PHCL. By August 2013, every RTO staff has attended the TRM course. In December 2013, we computed the average PHCL completion rate and also noted improvement. Physician/nurse improved from 95.5% to 98.8%, radiological technologist from 98.3% to 99.1% and radiological physicist from 99.6% to 99.7%. Through training courses, better check list design, placing the check list to the front page, multiple checking procedures, and caring health of our staffs, the PHCL is completed more thoroughly. It also further improved the flaws of sticking hand-off matters on the front of the medical records. Meanwhile, it can be added in as an essential of staff training. Through monitoring the completion rate of the PHCL, the errors in the operation procedures can be spotted, which can be improved with enhancing staff training or reviewing the work procedure.

並列關鍵字

team resource management (TRM) ； patient hand-off check list (PHCL) ； ISBAR