居家照護服務品質之評量與實例分享

Evaluation of Quality of Care in Home Nursing Care: A Case Analysis

林淑娟(Shu-Chuan Lin) ； 張雯姈(Wen-Ling Chang) ； 陳盈如(Ying-Ju Chen)

《馬偕護理雜誌》 3卷1期 (2009/01) Pp. 13-24

https://doi.org/10.29415/JMKN.200901_3(1).0002

摘要

居家照護服務對象包含病人、照顧者及其家庭，提供的服務係以全人照護為目標；筆者綜合文獻提出居家照護服務品質的評量可利用Donabedian理論之結構、過程與結果三個構面；再輔以主、客觀之品質評量要素，包含「服務提供者之結構與過程方面」及「服務使用者（病人）之結果方面」；並考量學者所提出「全人照護」與「以案主為中心的照護」理念，從病人及家屬、工作人員及行政管理三個層面並含括結構、過程與結果三個構面訂定評量內容及監測指標。實例分享以回溯性方式統計單位2006年留置導尿管重覆置換發生率，經由原因分析後，針對沉澱物多、滲尿、分泌物黏稠及外力拉扯”四項重覆置換原因，以戴明博士的PDCA品質管理循環模式，擬定改善方案，將2007年1至6月每月發生率目標值設定4%以下，並自2007年7月開始進一步將各項改善措施建立標準作業規範，再將發生率目標值降為3%以下。結果評值，統計2007年1至8月留置導尿管重覆置換發生率平均值為2.04%，相較於2006年平均值3.34%為低，顯示改善方案具明顯效益。但因評值期間較短，仍需密切觀察及持續進行改善及監控，方能確保留置導尿管居家照護個案服務品質之提昇。

關鍵字

居家照護 ； 服務品質 ； 評量

並列摘要

Home nursing care addresses the needs of patients, caregivers, and families as a whole. The goal should be holistic care. The author evaluated the literature, using the structure, process, and outcome of Donabedian evaluation theory as a vertical axis, and key subjective and objective elements of quality on the horizontal axis. These include structure and process for the providers and outcome for the patients. Concepts considered included holistic care and client-focused care. Patients, family staff, and administrators all participated in the evaluation. A retrospective case analysis design was used to compile statistics on the frequency of replacement of indwelling Foley catheters in our unit in 2006. There were four main reasons replacement: contaminated urine, infiltrated urine, thick urinary secretions, and removal of the catheter either deliberately by the patient or accidentally in the course of care. The Edwards Deming PDCA cycle provided a framework for a project to reduce the incidence of catheter replacement. The goal was to reduce the monthly incidence below 4% in the first half of 2007 and below 3% from July 2007 on. The average incidence throughout 2006 was 3.3%. Implementation of the plan reduced it to a mean of 2.0% for 2007. The improvement measures thus had a significant effect. Because the evaluation period was short, we need to continue careful observation and monitoring to insure that the improvement is maintained. However, our project appears to have succeeded in improving the quality of care for patients at home with indwelling Foley catheters.

並列關鍵字

home care ； service quality ； evaluation