以品管圈手法改善副木修改率

Decreasing the Rate of Splint Modification by Using a Quality Control Circle

林雁飛(Yen-Fei Lin) ； 李林富(Lin-Fu Lee) ； 林彣芷(Wen-Chih Lin)

《臺灣職能治療研究與實務雜誌》 12卷2期 (2016/12) Pp. 89-100

https://doi.org/10.6534/jtotrp.2016.12(2).89

摘要

目的：副木製作後因故需修改為職能治療師臨床工作常見的問題，本文欲探討可否藉由品管圈活動作為解決臨床問題的方法，並驗證其效果。方法：分析本科2014年1月至6月統計數據後，發現經由他科轉介之副木修改率達18.4%，故成立品管圈欲降低修改率。檢視修改原因，將其歸類為：醫囑單資訊不足、使用或保管不當、肢端腫脹、病程改變、有壓迫點。以柏拉圖驗證「醫囑單資訊不足」、「使用或保管不當」為問題要因，據此擬定以設計副木、製作肢體印章及將副木衛教單圖像化作為對策措施，並利用Plan-Do-Check-Action手法進行三項對策檢討和效果確認。以線性趨勢及Wilcoxon Ranks-Sum Test分析改善效果。結果：2014年1月至6月的修改率為17.9%至22.2%，其趨勢並無統計上的顯著差異(p = .468)，然而2014年7月至12月的修改率由25%逐月下降至0%，其趨勢呈現統計上的顯著差異(p = .013)。此外，2014年1月至6月與2014年7月至12月兩區間的修改率趨勢亦呈現統計上的顯著差異(p = .005)。延伸性效益方面，他科醫師對副木單和肢體印章皆感到滿意以上；而治療師使用圖式衛教單時，對於衛教時間、民眾接受度與整體執行程度上均有小程度至中等程度改善。據此修訂轉介副木製作流程並制定轉介副木作業標準書以建立標準化作業流程。結論：本品管圈成功的利用圖文方式促進醫療跨團隊溝通，所建立之標準作業流程可做為新進人員訓練及實習生教學。品管圈手法可使用於改善臨床問題，並據此標準化以持續改善效果。

關鍵字

副木 ； 品管圈 ； 品質改善

並列摘要

Objectives: Splint modification is a common problem in the routine clinical practice of occupational therapists. This study investigated the efficacy of implementation of a quality control circle(QCC) to decrease the rate of splint modification. Methods: Data collected from January to June 2014 were analyzed, and the results revealed that up to 18.4% of splints referred from other departments underwent adjustment because of insufficient information in the physicians' prescriptions, inadequate use or storage, extremity swelling, changes in disease course, or pressure points. A QCC was established to reduce the modification rate and improve the quality of splints. Through Pareto analysis, the QCC identified that ＂insufficient information in physicians' orders＂ and ＂inadequate use or storage＂ were the root causes of poor quality splints Accordingly, the QCC formulated three solutions, namely designing splint introduction leaflets, using body stamps in prescriptions, and creating graphical health education leaflets on appropriate splint usage, which were subsequently verified by the Plan-Do-Check-Action. The linear trend test and the Wilcoxon Ranks-Sum Test were use to estimate the difference of modification rate. Results: The modification rate from January 2014 to June 2014 was 17.9% to 22.2% (p = .468), but the modification rate presented the significant decreased from 25% to 0% (p = .013) between July 2014 to December 2014. The trend of those two time periods indicated a significant difference (p = .005). Furthermore, physicians rated the splint introduction leaflets and the design of the body stamps as satisfactory or above. Moreover, therapists recognized small to medium improvements in instruction time, patient acceptance, and overall performance because of the graphic health education leaflets. Finally, to standardize related procedures, the fabrication process of referred splints was revised, and a standard operation procedure (SOP) for splint referral was formulated. Conclusion: The QCC successfully facilitated interdisciplinary communication with a graphic approach. The resulting SOP is useful for training new staff and interns. The QCC method proved to be capable of providing solutions for clinical problems and resulting SOP to continue the improvement.

並列關鍵字

Splint ； Quality control circle ； Quality improvement