恢復室逾時滯留之研究 - 以某醫學中心為例

exploring the quality of (medical) care of which ovetime stay factor at (Post Anesthesia Care Unit，PACU) in one medical center.

何幸樺(Xing-Hua Ho)

指導教授 ： 白佳原

中山醫學大學/健康管理學院/醫療產業科技管理學系碩士班/碩士(2018年)

摘要

因重症病人增加及加護中心床位不足，造成麻醉手術後病人當日無法轉出去加護病房而留滯於恢復室。病人嚴重留滯恢復室會延遲常規手術進行，造成護理人力需求增加及影響院方營收。106年當中發現造成恢復室病患嚴重留滯原因有：一、在恢復室滯留超過兩小時處理麻醉或術後問題，因而影響滯留床位導致之負面影響，二、麻醉狀況解除後，外科醫師仍要求病人去加護病房，等待床位時留滯恢復室，院方因為病人以生命徵象不穩定，不可要求轉院，以免危及他人性命。三、加護中心床位不足，無法適時收住術後需加護照顧之病人。四、非預期性無法順利拔管，或是術後外科問題，在恢復室臨時要轉加護病房。執行改善措施：建立恢復室滯床處理流程，避免延遲常規手術進行及人力不足問題；設置「恢復室病人留滯的作業流程」評估病人病情變化，作為轉出恢復室之依據；統計及提供滯床數據，作為醫院增設加護中心床位之依據。目前每日平均滯床率16.75人，且逐年再往上增加 。

關鍵字

恢復室 ； 重症評估能力 ； 留滯病人滯床率

並列摘要

The main responsibilities of a nurse in post-anesthesia care unit (PACU) are to assist patients to regain consciousness safely and to prevent post-operation and anesthesia complications. Therefore, it is important that nurses are capable of critical care assessment. However, the critical care assessment and record taking abilities of PACU nurses are often inconsistent and incomplete. These deficiencies result in the delay of patients’ return to the PACU or delay in subsequent surgery as a result of a lack of identification of a patient’s special conditions, thereby affecting the surgical outcome. This study implemented four programs to resolve such issues: an advance critical care course, a revised checklist, case report analysis, and an audited nursing record. These programs improved post-operation nursing care from 70% to 80%. The accuracy and completeness ratings also increased from 80% and 78%, respectively, to 90%. The results of these programs improved the critical care assessment abilities and post-operative quality of care of PACU nurses and post-operative quality of care.

並列關鍵字

Post-anesthesia care unit ； critical care assessment ability

參考文獻

中文部分

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每週訊息•取自ttp://www.who.int/bulletin/volumes/89/6/11-088229/en/index.html

伍雁鈴、吳秋燕、張玉珠、劉棻合著（2009）。 手術室護理 。（347