建構呼吸照護措施降低內科加護病房病人48小時內非計畫性重返

非計畫性重返加護病房是重要的醫療品質指標。個案醫院2017年內科加護病房48小時內非計畫重返率為2.3%，較同年台灣臨床成效指標系統0.9%為高，重返以呼吸相關問題為最多。分析原因為呼吸相關評估工具不足、加護病房及普通病房護理師沒有確實執行追蹤及評值呼吸相關護理指導、呼吸治療人員未建立巡視由ICU轉出至普通病房病人之行政機制、主要照顧者缺少相關照護技巧。因此專案目的為降低內科加護病房48小時內非計畫重返率由2.3%至0.9%。本計畫活動期間自2018年03月至2019年12月，擬定對策方案：增加加護病房呼吸相關轉出評估表、醫療人員－－建立、追蹤呼吸相關護理指導規範及照護流程改善、主要照顧者－－建立學習及評值呼吸相關之護理指導機制。本專案結果為內科加護病房48小時內非計畫重返率由2.3%降至0.7 %，而將本專案所擬定之對策納入內科加護病房、普通病房及呼吸治療人員之呼吸照護常規，以提高加護病房病人之醫療品質。

關鍵字

非計畫性重返；加護病房；病人安全；呼吸照護

並列摘要

Unplanned readmission to the intensive care unit is a performance indicator of the quality of intensive care. In 2017, 2.3% of patients underwent unplanned readmission to the medical intensive care unit (MICU) within 48 hours of discharge from our general wards. This rate was higher than the Taiwan Clinical Performance Indicator average of 0.9%. Readmission is predominantly caused by breathing-related problems. This issue stemmed from the following reasons, including insufficient respiratory-related assessment tools, inadequate nursing training related to the tracking and evaluation of respiratory care in both the MICU and general ward, lack of protocols involved in tracking patients who had transferred from the MICU to the general ward, and insufficient knowledge of family caregivers caring for family members. We aimed to reduce the 48-hour unplanned readmission rate from 2.3% to 0.9%. The project period lasted from March 2018 to December 2019. We developed the following three multidisciplinary strategies for the MICU and ward teams, including incorporating additional respiratory-related criteria when evaluating patients for transfers out of the MICU, establishing and assessing respiratory-related nursing guidelines in addition to improving the SOP of nursing care, and providing guidance to family caregivers on respiratory evaluations. The 48-hour unplanned readmission rate decreased from 2.3% to 0.7%. These strategies have successfully reduced the 48-hour unplanned readmission of MICU patients and can be incorporated into routine respiratory care protocols to increase patient safety and medical care quality.

並列關鍵字

unplanned readmission ； intensive care unit ； patient safety ； respiratory care

參考文獻

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