- 學位論文
運用臨床警訊系統－降低病房非預計心跳停止事件
The application of clinical alert system to reduce unplanned in-hospital cardiac arrest events in wards
摘要
非預期心跳停止事件是衡量醫院醫療品質的重要指標。未能預先警告患者緊急情況的病情變化可導致與醫病溝通失去信任且造成家屬與醫療團隊身心疲憊。過去的臨床預警系統未能完成的呈現出病患的住院風險，這也導致醫生無法在病患病情轉變時完全且即時的掌握患者的病況。 創新的臨床警訊系統對病人進行全面的風險評估，同時提供適當的臨床醫護照護，減少醫院發生非預期心跳停止事件，提供病人更好的照護。創新臨床警訊系統包括過往臨床警訊系統評估的9項評核細項外，再加入符合台灣醫療現況所需要的評核項目，例如跌倒評估、家屬照護、咳痰能力和是否有簽屬放棄急救的同意書。透過紅黃綠燈的信號區分疾病嚴重度，因此醫護團隊可以快速掌握病人病情變化。所有住院病人的臨床警訊評估系統評估由醫生、專科護理師和護理師等人完成，當病人的病情從黃燈或綠燈變為紅燈時，臨床警訊系統會主動發送簡訊以通知醫生，以便可以立即警示出現緊急和病情不斷變化的病人。臨床警示系統的另一個應用是能對於不穩定住院病患導入分級護理照護，和分級醫療照護，例如快速反應小組的。 創新臨床警訊系統的改良有以下成果，將2017年的數據與2014年的數據進行比較，病危啟動急救事件數量從每月6.2次下降到每月2.8次;非預期心跳停止事件的事件從每月5.7次下降到每月2.1次;急救患者的生存率從29.8％上升到48.6％。包括70％的病危啟動急救事件發生時落於黃色或紅色警告區域。 本研究展示了臨床警訊系統的卓越性，致力於不斷改善病患的醫療照護品質。這種創新項目可以推行到其他醫院，使台灣和國外的其他醫院受益。
並列摘要
Unexpected cardiac arrest is an important indicator of hospital medical quality. Failure to pre-alert the emergency of a patient’s condition can result in communication breakdown with family and staff being left physically and mentally exhausted. Past clinical warning systems did not incorporate patient’s hospitalization risk factors, leaving physicians without the full grasp of the patient’s full condition in an emergency situation. This project, entitled “Clinical alert system” was designed and implemented to allow comprehensive risk assessment of patients while delivering appropriate clinical care, resulting in better quality provided to patients by reducing the unexpected cardiac arrest events in the hospital. This system includes the past Clinical alert system (CAS) assessment of nine projects, Taiwan’s national project of clinical care needs such as fall risk assessment, family care support, cough power, and whether to sign do not resuscitation. The signal of red and green light distinguishes the severity of the disease so medical staff can rapidly master the changes in the patient’s condition. Electronic medical records mandated the completion of the clinical alert systems for all hospitalized patients. This assessment was completed by physicians, nurse practitioners and nurses. When patient's condition changes from yellow or green light to red light, the clinical alert system proactively sends a newsletter to inform the physician, so that those who are offsite can immediately be warned of the emergent and changing conditions of the patients. One of the application to the “Clinical alert system,” includes the introduction of the nurse grading care guidelines as well as the rapid response team in the patient's emergency. Comparing the data results in 2017 with that of 2014, the numbers of emergency calls initiated due to critical illness dropped from 6.2 times/per month to 2.8 times/per month; the events of unexpected cardiac arrest dropped from 5.7 times/per month to 2.1 times/per month; the survival rate of patients with first-aid increased from 29.8% to 48.6% as a result of this improvement in the clinical alert system. 70% of the incidents are now captured in the yellow or red light warning areas. This project demonstrated the excellence of the clinical alert system in striving to continuously improve the medical quality of patient care. This type of innovative projects can be replicated to benefit other hospitals in Taiwan and abroad.
參考文獻
延伸閱讀
- 江金英、賀倫惠、莊月娥、謝錦榕、龔秀玲（2017）。跨團隊合作降低心臟內科病人非預期心跳停止急救的發生率改善專案。醫務管理期刊，18(1)，73-87。https://doi.org/10.6174/JHM2017.18(1).73
- 黃惠鈺、許惠珊、林渼璇、陳慧玲（2021）。降低心臟內科病房無線心電圖監測器非必要警報件數。新臺北護理期刊，23(2)，64-77。https://doi.org/10.6540/NTJN.202109_23(2).0006
- Kung, C. T. (2011). 住院病患在病房發生心跳停止影響急救預後之急救前因子 [master's thesis, Kaohsiung Medical University]. Airiti Library. https://www.airitilibrary.com/Article/Detail?DocID=U0011-1107201111192500
- 梁貴閔（2010）。院內心跳停止病人成功急救之相關因子探討〔碩士論文，臺北醫學大學〕。華藝線上圖書館。https://doi.org/10.6831/TMU.2010.00159
- 楊秀蘭、吳家榛（2012）。The Effectiveness of Reducing the Patients with Physical Restraint over 24 Hours in the Cardiac Care Unit。若瑟醫護雜誌，6(1)，53-65。https://doi.org/10.30145/STJHMNJ.201208.0005