運用高擬真情境模擬改善急診病人敗血症照護流程

Using high fidelity simulation improve sepsis bundle care at ED

吳宛庭(Wan-Ting Wu) ； 紀姿妃(Tzu-Fei Chi) ； 陳健驊(Jiann-Hwa Chen) ； 康春梅(Chun-Mei Kang) ； 詹佳孟(Chia-Meng Chan) ； 黃昭硯(Chao-Yen Huang) ； 黃鈺茹(Yu-Ju Hung) ； 詹淑惠(Shu-Hui Chan) ； 林佳琦(Chia-Chi Lin) ； 張文靜(Wen-Ching Chang) ； 秦文靜(Wen-Ching Chin) ； 王拔群(Pa-Chun Wang)

《台灣擬真醫學教育期刊》 2卷2期 (2016/02) Pp. 16-22

https://doi.org/10.6582/JTSSH.2016.2(2).02

摘要

過去許多研究運用情境模擬方法提升敗血症病人的照護，但是大多數著重於臨床技能，鮮少運用團隊合作技巧，然而敗血症的流程改善除了遵循國際治療指引外，更需要透過跨團隊整合與討論，因此個案醫院結合團隊資源管理於敗血症流程改善中，希望能以新思維加強團隊臨床技能及團隊合作技巧。參與模擬訓練學員中有85%認為課程設計是適當的，同時改善後的自信程度由改善前16.70%提升至66.70%，達統計上顯著意義(p＜0.01)，同時有4.6±0.5學員認為學習是很有趣的，有4.3±0.6的學員認為情境模擬可以增加學員的知識。透過演練人員執行敗血症照護流程的完整率由45.06%提升至60.19%，進一步追蹤12月完整率已達100%。團隊合作在醫療照護的過程已經是無法忽略的重要環節，醫療界除了持續加強照護品質及運用流程改善進行檢討分析，未來如何整合並落實醫療照護工作中，是各醫療院應共同努力的方向及目標。

關鍵字

敗血症 ； 模擬訓練

並列摘要

In the past, there were many studies employed the situational simulation to enhance the quality of care for the sepsis patients. Most of them focus on the clinical skills, and the teamwork skills were rarely used. However, to improve the protocol for the treatment of sepsis not only includes the compliance with international treatment guidelines, the cross-team integration and discussion were even more essential in the process. During the process to improve the sepsis protocol by combining team resources management with hoping the new thinking can resulting in strengthen the team clinical skills and teamwork skills. Among the students who participate in the high fidelity simulation training course, 85% thought that the course design is appropriate, and had improved their degree of confidence from 16.7% to 66.70%, reaching a statistically significant (p＜0.01). While there are 4.6±0.5 students consider the course is very interesting, and 4.3±0.6 students believe the situational simulations can increase the knowledge of participants. The medical staffs had increased their complete rate of sepsis care processes from 45.06% to 60.19% after participating the walkthrough training, and further increase to 100% after 12 months of follow up. Teamwork in the process of health care is essential and should never been ignored. In the medical profession, besides the continuing improving the quality of care and utilizing process improvement to review and analysis each step, the method of integration and implementation of the quality health care are the aim for every medical center in the future.

並列關鍵字

sepsis ； simulation training