推動全責照顧服務模式十年成效分析－以臺北市立聯合醫院為例

The Effectiveness Analysis on the Use of Total Care Model Over the Past Decade: Evidence from Taipei City Hospital

蔡衣帆(Yi-Fan Tsai) ； 陳雅芳(Ya-Fang Chen) ； 馮容莊(Rung-Chuang Feng)

《源遠護理》 9卷3期 (2015/09) Pp. 5-13

https://doi.org/10.6530/YYN/2015.5.11

摘要

臺北市立聯合醫院自2003年發展全責照顧服務，成立全責照顧委員會建置推動策略及規劃作業流程，包括：一、內外科病房、急重症單位及護理之家人力分配與管理制度：內外科病房以1：5，呼吸照護中心、護理之家以1：2.5，婦兒科以1：10，呼吸照護病房以1：3之比例配置；急重症單位（含急診加護單位）配置至多6人；精神專科急性及加護病房至多配置10人；社區護理則配置2-4人。二、辦理全責照顧人員培訓班及教育訓練。三、制定工作職責、派班原則、大小夜包班制度、全責照顧交班單。四、制定全責人員之照顧技術17項、精神專科2項，並進行技術稽核。照顧品質監測結果發現包括近5年陪病率約12%左右，病人或家屬、病房助理、護理人員對全責照顧服務滿意度約95%，跌倒發生率0.15%降至0.05%，壓瘡發生率1.16%降至0.01%，鼻胃管滑脫率介於0.02%~0.04%，導尿管滑脫率介於0.01%~0.03%，術後皮膚清潔率97.50%提升至99.08%。臺灣將於2017年執行長照服務法，所需之照顧人力配置、訓練機制、品質監測可參考其多年推展全責照顧的寶貴經驗。

關鍵字

技術混合照護模式 ； 全責照顧服務 ； 長期照護服務

並列摘要

Taipei City Hospital developed a “Total Care ”service model in 2003 and established a working committee to develop strategies and workflow planning.The committee produced: (1) Established staffing ratio:- Medical and Surgical wards = 1:5, Respiratory Care Center and Nursing Home = 1:2.5, Obstetric and Pediatric wards = 1:10, Emergency care and General wards ≤ 1:6, Respiratory Care Ward = 1:3, Psychiatric ward and intensive care unit ≤ 1:10, Community nursing care: 2-4; (2) Established a training program and provided training courses; (3) Established principles and responsibilities of shift assignments; (4) Standardized 17 caring skills, 2 psychological supporting skills, and performing competency validations; (5) Monitoring quality of care: accompany-patients rate about 12% in the recent 5 years, satisfaction to our “Total-responsibility for Care” service was about 95% among patients, families, ward assistants and nursing staff; incidence of patient fall rate reduced from 0.15% to 0.05%; pressure ulcer incidence reduced from 1.16% to 0.01%; nasogastric tube slippage rate was 0.02%-0.04%; foley catheter slippage rate 0.01%-0.03%; post-operative skin cleansing rate increased from 97.5% to 99.08%; (6) Reward for merit personnel and innovative activities. Long-term Care Service Law will become effective in Taiwan in 2017. Taipei City Hospital will be glad to share our “Total Care model”, our caring staffing, training program, quality monitoring experiences.

並列關鍵字

Skill-mix nursing model ； total care model ； long-term care service

參考文獻

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