運用協作平台建立高效率溝通機制以增進病人安全之研究-以血液透析室病人交班為例

Using the Collaborative Platform to Establish the Communication Mechanism among Medical Personnel to Enhance Patient Safety--- A Case Study of Shift at Hemodialysis Room

殷嘉瑜(Chia-Yu Yin)

指導教授 ： 徐隆榮

共同指導教授 ： 劉立

臺北醫學大學/醫學院/醫學資訊研究所/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00135

摘要

美國國家研究院醫學研究所(Institute Of Medicine of the National Academies,IOM)2000年「To Err Is Human」報告顯示，美國每年約有98,000人因醫療疏失而死亡，但藉由適當的資訊科技輔助，至少可將死亡人數降低45%。護理資訊化主要目標是提供病患適切的醫療照護，評值護理照護品質成果，對於需長期接受血液透析治療的病患來說，能大大降低因交班時的遺漏而造成疏失，落實照護病人安全機制。運用協作平台病安交班系統來輔助人類記憶之能力，降低病人安全問題的發生，並提供快速演算能力，不但可以節省時間，又可以減少人為錯誤發生的機會，增加病人直接照護的時間，對於日常性的人工資料收集、查詢與分析等費時作業將有值皆的助益，並提供後續的研究教學品質對於病患安全與醫療品質之提昇均有莫大的幫助。
研究中以某區域教學醫院的血液透析室為例，護理人員為改善既有的傳統交班方式，運用協作平台建置病安交班系統，在系統開發前，收集護理人員對資訊化的需求和臨床上使用的表單，待系統建立後，利用科技接受模式(Technology Acceptance Model，TAM)理論所設計的「臨床護理人員對協作平台病安交班系統之使用接受度量表」，對單位使用過該系統的護理人員共43位進行測試並探討護理人員對此科技系統接受行為所產生的效果及使用意願，在組織績效影響上可以提供醫院管理者在進行行動護理資訊系統時的參考外，也可以提供運用資訊科技接受模式於醫療資訊系統上的初步結果，進而提升效率與效能，或藉由交班平台的導入，提升護理人員的照護品質及溝通效果、完整性，進而提昇整體形象、有效的節省人力等。
研究工具透過自填式問卷方式進行探討，發放43份問卷，回收有效問卷共43份，有效回收率為100.0％。資料經由SPSS 15.0版統計套裝軟體進行描述性統計、t統計、單因子變異數分析、杜賓-瓦特生檢定(Durbin-Watson test)迴歸分析等統計方法進行資料分析。結果發現知覺易用性對知覺有用性有顯著的影響(P<0.01)，且知覺易用性會直接或間接的影響使用態度(P<0.05)，而知覺有用性對使用態度有顯著影響(P<0.01)，故系統帶給使用者操作容易性影響最大，而在於協作平台病安交班系統內的訊息可以使團隊中的合作夥伴共用與流通，系統的及時性、正確性和行動性也都會影響使用者的使用意願。
最後期望研究結果以提供機構未來建置的參考，將所得到資料加以彙整為資訊，並與病人安全、人力資源等相關管理作業系統資源整合、分析、研究，進而運用在臨床照護工作上，將能有效簡化護理人員在執行病歷記錄的時間，減少醫療疏失，提昇對長期血液透析病患的服務與照護品質。

關鍵字

協作平台 ； 病人安全 ； 交班 ； 科技接受模式

並列摘要

In 2000 The Institute Of Medicine of the National Academies (IOM) in "To Err Is Human" reports that in the United States about 98,000 people die due to medical errors each year, but the number of deaths could be reduced by at least 45% by appropriate information technology assistance. The major objectives of the nursing information systems are to provide patients with appropriate medical care, evaluate the quality of nursing care outcomes, and implement a care and patient safety mechanism. In particular, for the long-term hemodialysis patients, the system can greatly reduce errors due to the omission caused by negligence during shift changes. The Collaborative Shift Management and Patient Safety System can be used to aid human memory, reduce occurrence of patient safety issues, and provides rapid computational capability to not only save time, but also reduce probability of human error and increases time spent on direct patients care. The system can increase the efficiency of time-consuming routine manual data collection, query and analysis; and it will be of great help for both providing follow-up of quality of education for patient safety and improving healthcare quality.
Research is conducted on a regional teaching hospital hemodialysis room, where the nurses sought to improve the existing traditional shift management method by implementing a Collaborative Shift and Patient Safety System. Prior to system development the information system and data form requirements are collected from the medical personnel. After the system is established, a survey based on the Technology Acceptance Model (TAM) design theory, "clinical nurses collaboration platform shift patient safety systems user acceptance scale," is distributed to a total of 43 nurses in the group whom have used the new system to test and explore their behaviors and willingness to accept this technology systems. The impact on organizational performance from the use in hospitals can provide to hospital managers references when carrying out operations, and it can also provide preliminary results for information technology use acceptance model in medical information systems for efficiency and effectiveness improvements, or by introduction of shift management platform to enhance the quality of nursing care and communication effectiveness and integrity, thus improving the overall image, labor saving and so on.
Research data collection is through self-administered questionnaire. A total of 43 questionnaires are issued, 43 valid questionnaires are collected, and the effective rate was 100.0%. Data is analyzed using the statistical software SPSS version 15.0 for descriptive statistics, t statistics, single factor analysis of variance, Dubin-Watts test and regression analysis. The results showed that perceived ease of use on perceived usefulness has a significant impact (P <0.01), and perceived ease of use will directly or indirectly affect the attitude of use (P <0.05), while perceived usefulness had a significant impact on the attitude of use (P <0.01). Therefore, the system has greatest impact on ease of use, and the information within the Collaborative Shift Management and Patient Safety System allows the team to share and collaborate. As such, system timeliness, accuracy, and action also affect the willingness of user to adopt the system.
Finally, the research and its results are expected to provide reference for organizations establishing such a system in the future. By compiling the collected data into information and performing integration, analysis, and research with patient safety, human resources and other related resource management operations systems; the resulting information can be applied to clinical care and effectively simplify and decrease the time nursing staff spent on medical records, reduce medical errors, and improve service and care quality of long-term hemodialysis patients.

並列關鍵字

Collaborative Platform ； Patient Safety ； Shift ； Technology Acceptance Model

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