利用六標準差手法改善手術同意書簽署完整性

Improvement in Completion of Obtaining Preoperative Informed Consent Using the 6-Sigma Technique

劉惠琴(Hui-Chin Liou) ； 張嘉晃(Chia-Huang Chang) ； 王拔群(Pa-Chun Wang) ； 古雪鈴(Shei-Ling Ku)

《輔仁醫學期刊》 6卷2期 (2008/06) Pp. 79-86

摘要

背景及目的：手術同意書簽署不完整，醫護人員須花費額外時間處理簽署手續，以致延遲病人進入手術室的時間，進而影響手術室作業的順利。故導入六標準差手法提升手術同意書簽署完整性。方法：運用『DMAIC』流程改善的五大步驟，以病歷回溯方式及魚骨圖的製作，調查及探討簽署不完整原因。自2006年10月至2007年4月導入改善措施。結果：手術同意書共分為七部份，簽署完整率依序為：『簽署完整後第二聯給病人』：18%~29%(0.6δ~1.0δ)、『醫師聲明完整』：68%~85%(2.0δ~2.6δ)、『病人聲明完整』：73%~82%(2.2δ~2.5δ)、『擬實施手術說明完整』：85%~94%(2.6δ~3.2δ)、『手術醫師簽名完整』：88%~97%(2.7δ~3.4δ)、『立同意書簽名完整』：91%~95%(2.9δ~3.2δ)及『病人基本資料完整』：91%~97%(2.9δ~3.4δ)。介入六標準差管理後，每部份簽署完整率皆達90%以上，尤其在『病人基本資料』及『立同意書簽名』完整率達100%。結論：運用六標準差改善手法，不但有效降低手術同意書簽署的不完整率，同時也降低手術病人安全照護流程中，術前溝通不完善發生的機率，且減少病人進入手術房時間的延遲，對手術室的業務運轉績效更是有加分的效果。

關鍵字

六標準差 ； 手術同意書 ； 簽署完整性

並列摘要

Background and Purpose: Incompletion of obtaining informed consent can lead to operation delays and can incur additional management loading. The aims of this study were to use the 6-sigma method to improve the preoperative completion of informed consent for better communication between patients and healthcare workers. Methods: Following the DMAIC 6- sigma standard procedures, we retrospectively reviewed medical records and used a ”fishbone chart” to investigate the causes of incompletely obtaining informed consent. Prospective interventions were introduced during the period from October 2006 to April 2007. Results: There are 7 items which need to be completed prior to surgery. Before the intervention, the [intervention/completion?] rates were 18%~29% (0.6δ~1.0δ) for a 2nd copy to the patient, 68%~85% (2.0δ~2.6δ) for the doctor's claim, 73%~82% (2.2δ~2.5δ) for the patient's claim, 85%~94% (2.9δ~3.2δ) for the type of operation, 88%~97% (2.7δ~3.4δ) for the physician's signature, 91%~95% (2.9δ~3.2δ) for the patient's signature, and 91%~97% (2.9δ~3.4δ) for the patient's demographics. After the intervention, the completion rates rose to ＞ 90% (2.9δ~3.8δ) for all items. Conclusions: Introduction of the 6-sigma method proved to be effective in improving completion of obtaining informed consent and improving doctor-patient communication. At the same time, operation delays and management loading were successfully reduced.

並列關鍵字

6-sigma ； informed consent ； completion rate