運用跨團隊模式提升緊急手術醫護交班之完整率

To Improve the Completion Rate of Handover for Emergent Operation Cases Using Multidisciplinary Team Approach

李雨庭(Yu-Ting Li) ； 張雅萍(Ya-Ping Chang) ； 張春鳳(Chun-Feng Chang) ； 李嘉琪(Chia-Chi Lee) ； 賴東玲(Tung-Ling Lai)

《馬偕護理雜誌》 11卷2期 (2017/07) Pp. 24-35

https://doi.org/10.29415/JMKN.201707_11(2).0003

摘要

急診室接受緊急手術的病人，具有多專科性、高時效性及跨單位轉送等特性，若交班內容不完整，會使接班的手術團隊準備及病人處置方向錯誤，延遲手術影響疾病的預後，因而組成跨團隊小組，期望能提升交班的完整性。於2014年1月1日至1月31日進行查檢，結果緊急手術醫護交班總完整率為83.3%，進一步分析造成完整率低的原因為：交班單放置無法隨手取得、內容來源多又無一致性資訊來源、無規範手術排程輸入時間、未依交班單順序交班教育宣導不足、交班內容與病況無關或認為是醫師的事所以未交接班、交班者說太快或交班次序與單張不一致來不及寫、接班者英文拼字不熟悉，而造成來不及寫或未填寫。藉由建立緊急手術醫護交班標準內容及規範、整合現有交班資訊系統、建立緊急手術醫護電子交班共用系統、舉辦緊急手術醫護交班教育課程等解決方案，使得緊急手術交班完整率提升至98.5%，達目標值90%。電子交班資料完整且連結便利查詢，使得手術團隊於病人尚未至手術室報到，即可先查詢相關訊息掌握病情，減少聯繫時間，增加手術物品準備完整度，促進緊急手術病人手術全期醫護交接班信息傳遞完整性。

關鍵字

跨團隊 ； 緊急手術 ； 交班

並列摘要

Patients in the emergency room often require urgent surgery characterized with an unique, high efficient and cross-unit transfer system, and if handover is not completed, then it will lead to errors in the surgical team preparation, delay in operation, treatments, and prognosis for the patients. According to this issue, we planned to establish a cross-unit team approach to improve the completion rate of handover. After a survey investigation, the handover completion rate was 83.3% from the period of Jan. 1 to 31, 2014 prior to the implementation of the project. The analysis showed that there were some reasons which resulted in a low rate of completing handover. First, hand-over tool was not placed for convenience of the staff. Second, the source and content of handover were inconsistent. Third, the emergency surgery scheduling standard was absent. Moreover, handover training was insufficient for the staff. And, the biggest issue was the different understanding of patient's condition between staffs. Last, the staff spoke too fast or they were not familiar with the projects could all lead to misunderstanding of responsibility and accountability at work. After establishment of the approach in standardizing process and content of emergency surgery cases, integrating and executing handover system, processing the educational courses by the multidisciplinary-team work, the completion rates of handover emergency surgery cases was improved from 83.3% up to 98.5%, achieving the 90% target value. According to the comprehensive approach in the handover system, operative room staff can receive electronic information about patient's condition prior to the arrival. We have saved the time for communication enhanced the efficiency in the preparation of surgery materials. The project has improved the completion rate of handover of emergency surgery cases based on multidisciplinary team model, which has improved the patient's safety and continuous care as well.

並列關鍵字

multidisciplinary team ； emergency operation ； handover