川崎症住院病童友善醫療照護流程之改善專案

Friendly Health Care Improvement Program for Hospitalized Children with Kawasaki Disease

林怡攸(Yi-Yu Lin) ； 黃巧菱(Chiao-Lin Huang) ； 鄭家榛(Chia-Chen Cheng) ； 王敏惠(Min-Hui Wang) ； 林瓊君(Chiung-Chun Lin) ； 邱燕甘(Yen-Gan Chiou) ； 郭和昌(Ho-Chang Kuo)

《健康科技期刊》 7卷1期 (2020/09) Pp. 12-23

https://doi.org/10.6979/TJHS.202009_7(1).0002

摘要

目的：臨床發現川崎症住院病童發燒至確立診斷流程繁瑣，以致病童疼痛、家屬焦慮，對醫療產生抱怨。本文旨在改善川崎症住院病童友善醫療照護流程。方法：經現況分析發現：川崎症確診天數長達7.4天、病童疼痛不適致家屬產生焦慮、對團隊照護滿意度低、欠缺川崎症衛教輔助工具及診斷治療照護流程不完整是主要原因。經擬定改善措施：導入專區專人化照護、介入跨團隊照護、多元化跨時空衛教服務、修訂川崎症診斷治療標準化照護流程及建置資訊化發燒篩檢系統。結果：實施後，川崎症住院病童確診時間由7.4天降低至5天、病童疼痛指數由6.3分降至3分以下、家屬焦慮指數由78.3 mm降至30.1 mm、家屬對團隊照護滿意度提升至95.1%。討論：本專案的推行確實能改善醫療照護品質，並提升家屬對川崎症照護的滿意度。

關鍵字

川崎症 ； 住院病童 ； 友善醫療

並列摘要

Objective: Clinical experience shows a complicated process between a fever and a final diagnosis for a child with Kawasaki disease. The process often causes sick children to suffer in pain and parents to fall into anxiety and complaints about the health care system. The program is intended to improve the friendly health care for hospitalized children with Kawasaki disease. Method: Findings of present situation analysis: the time to diagnosis (TTD) being 7.4 days for Kawasaki disease; sick children suffering in pain causing anxiety in parents; low satisfaction with the care provided; a lack of educational tools for Kawasaki disease; and inadequate diagnosis and treatment procedures being the main reasons. Proposed improvements: creating a designated area staffed with full time carers; introducing cross-departmental care; implementing a variety of health education services free from space-time constraints; revising the standard diagnosis and treatment procedures for Kawasaki disease; and installing IT systems for fever screening. Results: Since the program was implemented, the TTD fell from 7.4 days to 5 days; the pain rating for sick children fell from 6.3 to 3 or lower; the parent anxiety rating fell from 78.3mm to 30.1mm; and the family satisfaction with the care provided rose to 95.1%. Discussion: The program is effective in improving the quality of health care and increasing family satisfaction with the care provided for Kawasaki disease.

並列關鍵字

Kawasaki Disease ； Hospitalized Children ； friendly medical care process

參考文獻

朱芳業 (2011)．標準化在醫療產業的 應用． 亞東醫院品質季刊，3 (4)，10-13。[Chu, F. Y. (2011). Apply standard operation procedure in medical industry. Far Eastern Hospital Quality Journal, 3(4), 10-13. doi:10.30164/YDYYPJJK.201111.0003]

沈青青、劉靈美、柯識鴻、龔怡萍、羅美如、田怡清 …吳麗芬 (2012)．接受緩和療護癌末兒童疼痛照護之臨床指引．榮總護理，29(4)，330-343。[Sheng, C, C., Liu, L. M., Ke, S. H., Kung, Y. P., Lo, M. J., Tien, Y. C.,…Wu, L. F. (2012). Clinical guidelines for palliative care of pediatric patients with cancer pain. VGH Nursing, 29(4), 330-343. doi:10.6142/VGHN.29.4.330.]

洪翠 妹、 洪芬 芳、 曾進 安 (2007)． 運用網路資訊登錄系統提高護理品管監測資料處理的效率．北市醫學雜誌，4(6)，68-77。[Hung, T. M., Horng, F. F., &Tseng, C. A. (2007). Using an information system to improve the efficiency of nursing management. Taipei City Medical Journal, 4(6), 68-77. doi:10.6200/TCMJ.2007.4.6.10]

郭和昌、劉又禎、梁啟迪、楊崑德(2011)．兒科十大棘手疾病之首-川崎症．臺灣醫界，54(2)，69-73。[Kuo, H. C., Liu, Y.C., Liang, C. D., & Yang, K. D. (2011). Kawasaki disease is one of the top ten intractable disease in pediatric. Taiwan Medical Journal, 54(2), 69-73. doi:10.30044/TMJ.201102.0002]

郭瓊文、李忠成、謝正芳 (2016)．難治型川崎病治療的回顧．南臺灣醫學雜誌，12(1)，1-10。[Kuo, C. W., Li, C. C., & Hsieh, C. F. (2016). Review of treatment for refractory kawasaki disease. Medical Journal of South Taiwan, 12(1), 1-10. doi:10.6726/MJ ST.201607_12(1).0001]