運用組合式照護改善健康照護品質

Using Care Bundles to Improve Health Care Quality

黃鈴婷(Ling-Ting Huang) ； 李佳晏(Chia-yen Li) ； 張乃文(Nai-Wen Chang)

《源遠護理》 11卷1期 (2017/03) Pp. 18-24

https://doi.org/10.6530/YYN/2017.5.3

摘要

「組合式照護（care bundles）」是為提升健康照護品質而發展出來，於2001年美國醫療照護改善研究機構（Institute for Healthcare Improvement, IHI）與志願醫院公會（Voluntary Hospital Association, VHA）聯合倡議，希望透過跨領域團隊的合作及溝通協調，透過3-5種有實證基礎的結構化重症照護措施，共同且確實的執行，以建立安全並可靠的照護條件改善照護過程和病人的健康結果。組合式發展剛開始著重於有潛在性傷害及高花費的問題，如呼吸機及中心導管病人之照護，透過實證基礎研究，強烈證據顯示實施「組合式照護」的效益極佳。本文藉由說明組合式照護之發展、設計、推行及成效等，以使醫療照護相關人員能更瞭解相關概念以改善照護品質。

關鍵字

組合式照護 ； 遵從性 ； 健康照護品質

並列摘要

Care bundles were developed for improving health care quality by the Institute for Healthcare Improvement (IHI) as part their joint initiative with the Voluntary Hospital Association, named Idealized Design of the Intensive Care Unit (IDICU) in 2001. They combined 3-5 evidence-based interventions to develop the process of improving critical care to the highest levels of reliability, which would result in considerably ameliorated outcomes. It was believed that improving teamwork and communication in multidisciplinary teams would facilitate the conditions necessary for safe and reliable care in the intensive care unit. They focused on regions with potential for great harm and high cost, and where the evidence base was robust. While there were many changes the teams where this initiative was implemented, the care of patients on ventilators and those who had central lines became a powerful focus, as it fulfilled all the criteria and produced reliable change and superior patient outcomes. By using a ＂bundle (a small set of evidence-based interventions)＂ with a defined patient population and care setting, the improvements in patient outcomes exceeded expectations. Thus began an innovative approach of the use of bundles to improve critical care. In this paper, we illustrate the history, theory of change, design concepts, and outcomes associated with the use of bundles for further implementation of the bundle approach to improving the quality of care.

並列關鍵字

care bundles ； compliance ； health care quality

參考文獻

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