提升手術室與恢復室術後病人交班的完整率

手術室與恢復室對於術後病人的交班常出現遺漏的現象，導致雙方護理人員需再以電話互相查詢，為提升術後交班的完整率，故引發本專案的改善動機，期望藉此專案提升交班總完整率及各單項完整率均達90%，確保術後病人獲得連續性與完整性的即刻照護。經現況分析發現，交班時不知恢復室負責護士、缺乏交班的在職教育課程、恢復室護士邊交班邊工作、無交班單、無審核制度。為改善上述的問題，本專案進行的解決辦法為修定交班標準單並定期審核、制訂手術室與恢復室交班單、製作恢復室負責護士公佈欄、舉行教育宣導及張貼標準單。透過本專案實施後總完整率、各單項交班完整率皆達90%，不僅改善雙方交班問題，亦使手術後病人得到高品質完整性的照護。

關鍵字

交班；術後病人；完整率

並列摘要

When patients are transferred from the operating room to the recovery room, there are often communication gaps between nurses in the two units, leading to omissions in important information about the patient. Telephone inquiries are frequently needed to fill in the missing information, which in inefficient for staff in both units. We designed a project to improve the integrity operating room nursing reports, aiming for a standard of 90% completeness. We analyzed the problems with reports and found they included a lack of training to promote continuity of nursing care, distraction of the recovery room nursing staff when receiving patients, lack of a standardized nursing report form, and no system to monitor and verify the adequacy of reports. Those issues were addressed by establishing a standardized report form and methods to verify that the standards were being met, use of a bulletin board in the recovery room where the report was clearly posted, and holding a training course for the nursing staff explaining the new practices. After implementation of the project, we achieved the desired 90% integrity of the nursing reports.

並列關鍵字

nursing shift report ； post-operative patients ； integrity rate

國際替代計量

提升手術室與恢復室術後病人交班的完整率

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