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題名:提昇神經內科病房院內急救完整性之專案
書刊名:長庚護理
作者:鄭青青張乃丹林幼麗賀倫惠余文彬郭惠敏
作者(外文):Cheng, Ching-chingChang, Nai-tanLin, Yu-liHo, Lun-huiYu, Wen-pinGuo, Sophie Huey-ming
出版日期:2017
卷期:28:1=97
頁次:頁85-99
主題關鍵詞:院內急救急救知識團隊合作情境模擬In-hospital resuscitationRescue knowledgeTeamworkSituation simulation-based
原始連結:連回原系統網址new window
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  • 被引用次數被引用次數:期刊(1) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:1
  • 共同引用共同引用:17
  • 點閱點閱:5
背景:醫院內的急救過程複雜常需專業團隊合作,例行的急救訓練不代表能協同完成急救。當急救過程不完整相對危險性增加,患者死亡率與醫療糾紛率也將提升。目的:本研究透過執行專案提升急救完整度,藉由神經內科病房急救問題的剖析、改善醫護人員急救知識與團隊合作。解決方案:分析本科別急救完整率僅71%,急救作業認知答對率為60.9%,經由訪談與要因分析,發現問題在「急救用物準備」、「急救設備使用」、「急救藥物給藥」、「急救團隊合作」這四大方面不完整。經問題分析與矩陣圖擬定改善方案包括制訂急救標準作業流程、職責分配辦法、模擬情境案例及演習方式,並運用增進團隊合作的圖卡提示(職責分配對照圖、急救車藥物及醫材圖卡、電擊器及心電圖監視器簡易操作圖卡、禁N藥物照片圖卡及提示語),以落實方案的執行。結果:護理人員急救知識分數在實施前測平均6.09分(滿分10分),後測平均分數9.23分(t =10.46,p< .001);急救過程完整率實施前平均11.06分(總分17分),實施後顯著提升至平均值16.06分(t =13.04,p< .001)。結論:本專案建立急救完整率提昇方案,以標準化流程與情境模擬、圖卡提示來強化團隊合作,多管並行下有效提升急救完整度與知識,進而增進醫護人員對於急救熟悉度。此結果將可供對於急救知識技能需要加強的單位或人員,作為常規急救訓練的補強作法。
Background: In-hospital resuscitation, an urgent and complicated procedure, is often carried out by a multidisciplinary team. Resuscitation accreditation as a routine does not guarantee that team members can complete such task cooperatively. Incomplete cardiopulmonary resuscitation will increase mortality and result in more medical disputes. Purpose: The study described a project to enhance the completeness of in-hospital resuscitation by exploring problems of resuscitation process, improving rescue knowledge, and facilitating cooperative teamwork. Solution: After analysis, the completion rate of performing resuscitation in our neurology ward was only 71%. Percentage of correct response on resuscitation knowledge was 60.9%. Group interviews and causes analysis were used to identify problems, which included four aspects: (1) preparation of rescue devices; (2) usage of medical equipment; (3) drugs delivery; and (4) team cooperation. A project was implemented to solve these problems step-by-step, including making a matrix map, creating a standardized procedure, establishing responsibilities and accountabilities, and performing simulation-based drill activities. In particular, a tip of reminder cards was designed to prompt teamwork cooperation. Content in these cards included responsibilities comparison chart, pictures of ambulance drugs and medical material, demonstration of defibrillators and ECG monitors, and drug pictures with reminders. Result: aAfter implementing the project, average score of resuscitation knowledge increased from 6.09 out of 10 to 9.23. Average score of resuscitation completion has significantly increased from 11.06 out of 17 to 16.06. Conclusion: This project improved the performance of in-hospital resuscitation, Moreover, it effectively enhanced skills and knowledge among rescue team members. This results can serve as a reference for improving the quality of resuscitation.
期刊論文
1.魏自宜、李佳樺、王怡婷、陳麗貞、范君瑜、康世晴(20111200)。提升急診「外傷急救小組」啟動的正確性及作業流程之完整性。長庚護理,22(4)=76,506-517。new window  延伸查詢new window
2.吳俊穎、楊增暐、陳榮基(20131200)。醫療糾紛鑑定的維持率:二十年全國性的實證研究結果。科技法學評論,10(2),203-238。new window  延伸查詢new window
3.郭書麟、鄭嘉惠、卓淑玲、洪聖惠、王拔群(20140600)。急重症高擬真模擬情境團隊訓練成效初探。輔仁醫學期刊,12(2),89-96。  延伸查詢new window
4.楊子孟、王嘉地、林宏榮、郭雅薇、周淑蓮、黃首詠、林銘薰(20121100)。團隊急救復甦訓練新模式--以高擬真模擬情境考驗提升團隊合作效能。醫療品質雜誌,6(6),70-76。new window  延伸查詢new window
5.林芳怡、李慈音、吳維紋(20060100)。創新教學法運用於兒科護理學實習護生之感受。醫護科技學刊,8(1),8-19。new window  延伸查詢new window
6.李玉茹、王怡婷(2013)。搶救一瞬間--談急救能力與經驗。志為護理--慈濟護理雜誌,12(2),14-21。  延伸查詢new window
7.郭惠敏、謝靜萍、張雪玲、蔡慧芳、黃淑芬、彭淑卿、高淑芬(20061200)。電腦輔助急救學習之成效探討:階段一--以提升某專科護理學生急救知識技能之研究為例。醫療資訊雜誌,15(4),81-93。new window  延伸查詢new window
8.Abella, B. S.、Alvarado, J. P.、Myklebust, H.、Edelson, D. P.、Barry, A.、O'Hearn, N.、Becker, L. B.(2005)。Quality of cardiopulmonary resuscitation during inhospital cardiac arrest。The Journal of the American Medical Association,293(3),305-310。  new window
9.Aune, S.、Eldh, M.、Engdahl, J.(2011)。Improvement in the hospital organization of CPR training and outcome after cardiac arrest in Sweden during a 10-year period。Resuscitation,82(4),431-435。  new window
10.Clapper, T. C.、Ng, G. M.(2013)。Why Your TeamSTEPPS™ Program May Not Be Working。Clinical Simulation in Nursing,9(8),e287-e292。  new window
11.Clapper, T. C.、Kong, M.(2012)。TeamSTEPPS®: The patient safety tool that needs to be implemented。Clinical Simulation in Nursing,8(8),e367-e373。  new window
12.Lin, M. H.、Peng, L. N.、Chen, L. K.(2012)。Cardiopulmonary resuscitation for hospital inpatients in Taiwan: An 8-year nationwide survey。Resuscitation,83(3),343-346。  new window
13.Roh, Y. S.、Lee, W. S.、Chung, H. S.、Park, Y. M.(2013)。The effects of simulation-based resuscitation training on nurses' self-efficacy and satisfaction。Nurse education today,33(2),123-128。  new window
14.Wheeler, D. S.、Geis, G.、Mack, E. H.、LeMaster, T.、Patterson, M. D.(2013)。High-reliability emergency response teams in the hospital: improving quality and safety using in situ simulation training。BMJ quality & safety,22(6),507-514。  new window
15.Yang, C. W.、Yen, Z. S.、McGowan, J. E.、Chen, H. C.、Chiang, W. C.、Mancini, M. E.、Ma, M. H. M.(2012)。A systematic review of retention of adult advanced life support knowledge and skills in healthcare providers。Resuscitation,83(9),1055-1060。  new window
其他
1.財團法人醫院評鑑暨醫療品質策進會(2012)。醫療品質獎,http://hqic.tjcha.org.tw/HQIC/award.do?act=show&userId=12-A10125。  延伸查詢new window
2.American Heart Association(2010)。Guidelines for CPR and ECC,http://www.heart.org/HEARTORG/ CPRAndECC/Science/2010-AHA-Guidelines-for-CPR-ECC_UCM_317311_SubHomePage.jsp/。  new window
 
 
 
 
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