- 期刊
提升全院小於48小時營養不良篩檢高危險群會診完成率
Improvement of Less than 48 Hours Dietician Consultation Completion Rates for Inpatients at Risk of Malnutrition
摘要
住院營養不良與加長住院天數、高比例感染併發症及死亡率有關，故營養不良高危險群病人能即時轉介營養師相對重要。在臺灣目前醫療機構有限的營養師人力資源，如何掌握營養會診評估時效，是臨床營養工作之重要課題。本專案成立品管圈（quality control circle, QCC），由營養、護理、資訊相關醫療及行政人員做為品質改善小組成員，目的探討在全院一般病房影響營養師48小時內會診完成率之相關因素，並進行相關改善措施，也探討癌症營養不良高風險群之主要癌別。此專案收集本院民國101年10月住院營養不良病人，要因分析發現，營養師門診工作職責時段別及病房臨床科別二者為營養師於48小時內無法完成會診主要原因，而專案實施前101年9月至11月營養師平均48小時內會診完成率為77.2%。專案擬定三大策略進行會診時效改善，改善措施如下：一、建立營養師科別及門診時段排班標準化；二、資訊系統自動設定小於48小時完成會診提醒，並新增即時查詢營養師未完成會診名單功能；三、建立及落實營養師休假固定職務代理人制度。專案執行後至專案持續改善期，48小時內完成率由77.2%（101年9月至11月），上升至102年平均會診完成率92.7%，及103年為97.9%，提升小於48小時內營養師會診完成率20-26%。而癌症營養不良高風險病人48小時內完成率也由基線99.6%至專案完成後100%，高風險主要癌別為口腔癌最多，其次為血液腫瘤及食道癌。此外，經過專案改善，亦減輕營養師每月24小時人工處理資料及計時工讀費每月約3000元支出。本專案在醫療人員團隊合作下，提升營養師48小時內會診完成率，有益於改善住院營養不良及癌症營養不良病人提早接受營養介入，促進住院病人接受醫療團隊營養照護品質。
並列摘要
Malnutrition in hospitals generally correlates with prolonged hospital stays, increased prevalence of infections, and increased mortality rates. It is thus important to refer patients at high risk of malnutrition to registered dieticians in a timely manner for optimal assessment and nutrition intervention. Because dietician manpower is limited in hospitals, we aimed to improve the rates of completion of 48-hour dietician consultation in our hospital’s general wards as well as cancer wards using quality control circle (QCC) team including dieticians, nurses, and information technology staff members. Through vigorous analysis and discussion, reasons for incomplete consultation were found to be mainly due to clinical characters of wards and outpatient time slot assignment to dietician specialists. Three improvement strategies were implemented from January, 2013 to December 2014: (1) establish standard time slot assignment to outpatient consultation for dieticians with high patient care workloads, (2) implement a technology information system allowing instant access to patient lists with incomplete dietician consultation, and (3) arrange substitute dieticians for dieticians taking leave for various reasons. Before implementing these strategies, rates of consultation completion by dieticians within 48 hours was 77.2% from September to November of 2012. After implementation, consultation completion rates increased from 77.2% at baseline (November, 2012) up to mean completion rates of 92.6% in 2013 and 97.9% in 2014. For cancer patients at high malnutrition risk, the completion rates of dietician consultation reached 99.6% in 2012, and up to 100% in 2014. High prevalence rates of malnutrition risks were founds in patients with oral cancer. Additionally, implementation of this improvement project also cut down 24 working hours of a dietitian, and total hourly payments for part-time employees about 3,000 NT dollars per month. In conclusion, implementation of this improvement project successfully improved completion rates of consultation by dieticians within 48 hours of referral and may facilitate better quality of nutrition care for patients at higher risk of malnutrition, especially oral cancer patients.