- 期刊
提升臨時醫囑給藥執行時效性之專案
A Program to Improve the Overall Time for stat Medications
摘要
背景：本專案為提升內科加護病房臨時醫囑給藥時效性，改善前臨時醫囑開立後30分鐘內給藥達成率僅22.2%，低於文獻所報告之統計值，且給藥逾時最長達2～3小時，影響重症病人獲得適當治療的時效性。分析延遲的原因有：傳送延遲、護理師忙於其他處置、護理師認知不足認為醫囑不急迫、缺乏有效醫護溝通、代簽收藥品後未適當交班等。目的：臨時給藥醫囑30分鐘內完成給藥之達成率由22.2%提升至91.0%。解決方案：成立專案小組，分析要因後，推動透過建置智慧藥櫃、兩人團隊互助模式、在職教育、開方提醒立牌、臨時醫囑專用藥盒使用等措施。結果：臨時醫囑給藥執行完成時間由平均64.2分鐘縮短至17.0分鐘。2019年1～5月臨時醫囑30分鐘內給藥達成率提升至92.1%，達專案目標值，6～7月追蹤成效94.8%。結論：透過建置智慧藥櫃及臨床建立有效溝通及團隊互助模式，可有效提升臨時醫囑的給藥時效。
並列摘要
Background: This study aims to improve the timeliness of stat orders in the medical intensive care unit. Before our program, the rate of drug delivery within 30 minutes after stat orders were issued was 22.2%, which is lower than the rate indicated in the literature. In addition, the stat drug administration could be delayed up to 2 to 3 hours. Both conditions affect the correctness and timeliness of treatment for critically ill patients. The reasons of delayed drug administration included the following: transmission delay, nurses being busy with other treatments, a lack of understanding that stat orders should be very urgent, a lack of communication between doctors and nurses, and misplacement of delivered stat medications. Purpose: To increase the rate of drug administration within 30 minutes of stat orders from 22.2% to 92.1%. Methods: After setting up the project team and identifying the key factors of the problem, several strategies were implemented, including the following: an automated dispensing cabinet, a two-person team assistance model, an in-service education program, standing signs of stat orders, and special boxes for stat order medications. Results: The time to give stat medication improved from 64.2 minutes to 17.0 minutes on average. From January 2019 to May 2019, the rate of stat drug administration within 30 minutes of stat orders increased to 92.1%. We thus reached our target goal of the program. The rate of stat drug administration within 30 minutes of stat orders during the follow-up period on June and July 2019 was up to 94.8%. Conclusions: To improve the timeliness of stat orders of drug delivery, we recommend establishing an effective communication and team assistance model and implementing an automated dispensing cabinet in clinical settings.