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題名:運用團隊資源管理提升全身麻醉術後病人之體溫
書刊名:護理雜誌
作者:方雅晶陳燕雪劉玉婷林姿佳
作者(外文):Fang, Ya-chingChen, Yen-hsuehLiu, Yu-tingLin, Tzu-chia
出版日期:2017
卷期:64:3
頁次:頁82-89
主題關鍵詞:全身麻醉低體溫團隊資源管理麻醉恢復室General anesthesiaHypothermiaTeam resource managementPost-anesthesia room
原始連結:連回原系統網址new window
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  • 共同引用共同引用:5
  • 點閱點閱:1
背景:術後低體溫會使病人麻醉甦醒延遲,或甦醒過程中因顫抖而感到不適,增加身體耗氧量、增加手術傷口感染及合併症發生的機會。調查本單位全身麻醉術後病人體溫回升之現況發現,病人入恢復室第60分鐘後體溫 ≥ 36℃僅佔74%。分析原因包括:保暖設備不足、缺乏標準流程與稽核制度、護理人員對低體溫認知不足,以及醫護團隊於手術全期未做好保暖措施。目的:本專案目的為運用團隊資源管理,提升全身麻醉術後病人體溫在進入恢復室第60分鐘,體溫達36.0℃比率由74%提升至100%。解決方案:本專案透過建立保暖標準作業流程、定期稽核、增加保暖設備、舉辦在職教育,及運用團隊資源管理與手術室護理人員共同執行保暖計畫,以提昇全身麻醉術後病人之體溫。結果:病人入恢復室第60分鐘後體溫 ≥ 36℃的比率由74%提升至100%。結論:本專案執行成果顯示,跨團隊合作可有效提升全身麻醉術後病人低體溫之改善,進而增加麻醉手術後之照護品質。
Background & Problems: Hypothermia is the cause of multiple problems such as delayed awaking from anesthesia, feelings of discomfort, increased oxygen consumption, and increased risks of surgical wound infection and complications. A review of the record of post-operative patients receiving general anesthesia (GA) revealed that only 74% of the patients in our post-anesthesia room (PAR) had restored their body temperature to 36℃ after 60 minutes. Through situation analysis, several causes were identified, including insufficient warming facilities, lack of standard procedures and an audit system, lack of knowledge regarding hyperthermia among nurses, and the incompleteness of perioperative warming interventions performed by the healthcare team. Purpose: The aim of the present project was to apply team resource management (TRM) to raise the rate of body temperature restoration to 36℃ after 60 minutes in our post-anesthesia room (PAR) from 74% to 100%. Resolution: Several strategies were implemented to accelerate the post-operative rewarming for patients receiving GA, including: establishment of standard operating procedures for warming, conducting routine audits, purchasing warming facilities, conducting in-service education, applying TRM, and cooperating with nurses in operating rooms on executing the warming plan. Result: After implementing these strategies, our PAR achieved a 100% success rate in raising the body temperature of postoperative patients to 36℃ after 60 minutes. Conclusions: The result demonstrates that hypothermia may be effectively avoided and that the quality of postoperative care may be effectively improved through transdisciplinary teamwork.
期刊論文
1.徐慧興、張世琦、潘靜怡、劉曉雲(20141200)。運用團隊資源管理提升外科病房醫護團隊之訊息連結及值班滿意度。醫務管理期刊,15(4),277-289。new window  延伸查詢new window
2.施佳玟、李雅欣、王桂芸(20100900)。全身麻醉後低體溫引發寒顫之護理。長庚護理,21(3)=71,299-306。new window  延伸查詢new window
3.李福莉、鍾玉珠、何雪華、古雪鈴(20050300)。保溫措施對腹部手術患者體溫及麻醉恢復之影響。慈濟護理雜誌,4(1),42-50。  延伸查詢new window
4.陳慈桑、魏方君(20110900)。比較兩種回溫設備對於骨科手術病人回溫及舒適度之效果。榮總護理,28(3),258-265。new window  延伸查詢new window
5.陳清芬、張德馨、郭俐伶、黃瓊瑤(2009)。提升全身麻醉手術後病人體溫回升速率之方案。馬偕護理雜誌,3(1),55-64。  延伸查詢new window
6.Bashaw, M. A.(2016)。Guideline implementation: Preventing hypothermia。AORN Journal,103(3),304-313。  new window
7.Hegarty, J.、Walsh, E.、Burton, A.、Murphy, S.、O'Gorman, F.、McPolin, G.(2009)。Nurses' knowledge of inadvertent hypothermia。AORN Journal,89(4),701-704。  new window
8.Hooper, V. D.、Chard, R.、Clifford, T.、Fetzer, S.、Fossum, S.、Godden, B.、Wilson, L.(2010)。ASPAN's evidence-based clinical practice guideline for the promotion of perioperative normothermia: Second edition。Journal of PeriAnesthesia Nursing,25(6),346-365。  new window
9.Kurz, A.(2008)。Thermal care in the perioperative period。Best Practice & Research Clinical Anaesthesiology,22(1),39-62。  new window
10.Macario, A.、Dexter, F.(2002)。What are the most important risk factors for a patient's developing intraoperative hypothermia?。Anesthesia & Analgesia,94(1),215-220。  new window
11.Rowley, B.、Kerr, M.、van Poperin, J.、Everett, C.、Stommel, M.、Lehto, R. H.(2016)。Perioperative warming in surgical patients: A comparison of interventions。Clinical Nursing Research,24(4),432-441。  new window
圖書
1.Ronald, D. M.、Manuel, C. P.、張家穎、洪明輝、藍正妍、王婷鈺、許銘哲、林宜樺、王顥景(2014)。Miller大師引領您讀通麻醉學:麻醉學的基礎讀本。台北:合記圖書。  延伸查詢new window
2.The American Institute of Architects(2006)。Guidelines for design and construction of hospital and health care facilities。Washington, DC:The American Institute of Architects。  new window
 
 
 
 
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