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題名:以品管圈手法改善副木修改率
書刊名:臺灣職能治療研究與實務雜誌
作者:林雁飛李林富林彣芷
作者(外文):Lin, Yen-feiLee, Lin-fuLin, Wen-chih
出版日期:2016
卷期:12:2
頁次:頁89-100
主題關鍵詞:副木品管圈品質改善SplintQuality control circleQuality improvement
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)
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  • 點閱點閱:2
目的:副木製作後因故需修改為職能治療師臨床工作常見的問題,本文欲探討可否藉由品管圈活動作為解決臨床問題的方法,並驗證其效果。方法:分析本科2014年1月至6月統計數據後,發現經由他科轉介之副木修改率達18.4%,故成立品管圈欲降低修改率。檢視修改原因,將其歸類為:醫囑單資訊不足、使用或保管不當、肢端腫脹、病程改變、有壓迫點。以柏拉圖驗證「醫囑單資訊不足」、「使用或保管不當」為問題要因,據此擬定以設計副木、製作肢體印章及將副木衛教單圖像化作為對策措施,並利用Plan-Do-Check-Action手法進行三項對策檢討和效果確認。以線性趨勢及Wilcoxon Ranks-Sum Test分析改善效果。結果:2014年1月至6月的修改率為17.9%至22.2%,其趨勢並無統計上的顯著差異(p = .468),然而2014年7月至12月的修改率由25%逐月下降至0%,其趨勢呈現統計上的顯著差異(p = .013)。此外,2014年1月至6月與2014年7月至12月兩區間的修改率趨勢亦呈現統計上的顯著差異(p = .005)。延伸性效益方面,他科醫師對副木單和肢體印章皆感到滿意以上;而治療師使用圖式衛教單時,對於衛教時間、民眾接受度與整體執行程度上均有小程度至中等程度改善。據此修訂轉介副木製作流程並制定轉介副木作業標準書以建立標準化作業流程。結論:本品管圈成功的利用圖文方式促進醫療跨團隊溝通,所建立之標準作業流程可做為新進人員訓練及實習生教學。品管圈手法可使用於改善臨床問題,並據此標準化以持續改善效果。
OBJECTIVES: Splint modification is a common problem in the routine clinical practice of occupational therapists. This study investigated the efficacy of implementation of a quality control circle(QCC) to decrease the rate of splint modification. METHODS: Data collected from January to June 2014 were analyzed, and the results revealed that up to 18.4% of splints referred from other departments underwent adjustment because of insufficient information in the physicians’ prescriptions, inadequate use or storage, extremity swelling, changes in disease course, or pressure points. A QCC was established to reduce the modification rate and improve the quality of splints. Through Pareto analysis, the QCC identified that “insufficient information in physicians’ orders” and “inadequate use or storage” were the root causes of poor quality splints Accordingly, the QCC formulated three solutions, namely designing splint introduction leaflets, using body stamps in prescriptions, and creating graphical health education leaflets on appropriate splint usage, which were subsequently verified by the Plan–Do–Check–Action. The linear trend test and the Wilcoxon Ranks-Sum Test were use to estimate the difference of modification rate. RESULTS: The modification rate from January 2014 to June 2014 was 17.9% to 22.2% (p = .468), but the modification rate presented the significant decreased from 25% to 0% (p = .013) between July 2014 to December 2014. The trend of those two time periods indicated a significant difference (p = .005). Furthermore, physicians rated the splint introduction leaflets and the design of the body stamps as satisfactory or above. Moreover, therapists recognized small to medium improvements in instruction time, patient acceptance, and overall performance because of the graphic health education leaflets. Finally, to standardize related procedures, the fabrication process of referred splints was revised, and a standard operation procedure (SOP) for splint referral was formulated. CONCLUSION: The QCC successfully facilitated interdisciplinary communication with a graphic approach. The resulting SOP is useful for training new staff and interns. The QCC method proved to be capable of providing solutions for clinical problems and resulting SOP to continue the improvement.
期刊論文
1.施光庭、蔡紘僥(20070600)。以品管圈活動提升物理治療紀錄完整率。物理治療,32(3),105-113。  延伸查詢new window
2.蔡慈儀、蔡憶文、郭耿南(20101100)。醫療照顧體系中的健康溝通。臺灣醫學,14(6),607-615。  延伸查詢new window
3.郭英調(20050500)。醫療品質概論。臺灣醫學,9(3),392-394。  延伸查詢new window
4.江東懋、梁明貴、陳宛伶、陳玉娉、楊雅雯、邱淑芬(20120300)。利用品管手法可以改善復健科門診病患的治療滿意度--以新竹市某地區醫院為例。輔仁醫學期刊,10(1),13-19。  延伸查詢new window
5.杜家宏、吳文峯、趙敏(20130300)。運用品管圈手法提升骨質密度分析正確率。中華放射線技術學雜誌,37(1),22-30。  延伸查詢new window
6.徐瑜敏、商弘昇、蔡玲矯、張錦標(20140700)。應用QCC以降低門診抽血等候時間之研究。中華職業醫學雜誌,21(3),167-176。  延伸查詢new window
7.張文典、黎秉東、林鋐宇、陳念筑(20110900)。品管圈改善醫院復健治療流程之研究。中西整合醫學雜誌,13(3),17-28。  延伸查詢new window
8.張文典、黎秉東、蔡建宗、詹曉倩(20110600)。品管圈活動運用於解決醫院單位成本問題之實務:以某復健中心為例。健康管理學刊,9(1),17-27。new window  延伸查詢new window
9.張惠晴、蘇芬蘭、方淑華、王淑貞、鍾惠君、林彥光、吳雅汝(20140800)。運用團隊資源管理降低護理人員給藥中斷之改善專案。志為護理,13(4),70-80。  延伸查詢new window
10.陳志鳴、周瓊珍(20020400)。從品質觀點初探物理治療轉介流程。秀傳醫學雜誌,3(2/3),95-101。  延伸查詢new window
11.Epstein, R. M.(1995)。Communication between primary care physicians and consultants。Archives of Family Medicine,4(5),403-409。  new window
12.Fess, E. E.(2002)。A history of splinting: To understand the present, view the past。Journal of Hand Therapy,15(2),97-132。  new window
13.Kripalani, S.、LeFevre, F.、Phillips, C. O.、Williams, M. V.、Basaviah, P.、Baker, D. W.(2007)。Deficits in communication and information transfer between hospital-based and primary care physicians: Implications for patient safety and continuity of care。Jama,297(8),831-841。  new window
14.Shannon, D.(2012)。Effective physician-to-physician communication: An essential ingredient for care coordination。Physician Executive,38(1),16-21。  new window
15.Stille, C. J.、McLaughlin, T. J.、Primack, W. A.、Mazor, K. M.、Wasserman, R. C.(2006)。Determinants and impact of generalist–specialist communication about pediatric outpatient referrals。Pediatrics,118(4),1341-1349。  new window
16.Woolf, S. H.、Kuzel, A. J.、Dovey, S. M.、Phillips, R. L.(2004)。A string of mistakes: The importance of cascade analysis in describing, counting, and preventing medical errors。The Annals of Family Medicine,2(4),317-326。  new window
圖書
1.薛漪平、蔡佩倫、林克忠、潘璦琬、張瑞坤、劉倩秀、張綺芬(2013)。生理疾病職能治療學II介入理論與技巧。台北市:禾楓。  延伸查詢new window
2.Coppard, B. M.、Lohman, H.(2008)。Introduction to splinting。Elsevier Health Sciences。  new window
3.Ernst, F. G.(1883)。Orthopedic apparatus。London:Sprague。  new window
4.Glanze, W. D.、Anderson, K. N.、Anderson, L. E.(1990)。Mosby's Medical Nursing, and Allied Health Dicitionary。St. Louis:Mosby。  new window
5.Institute of Medicine (US) Committee on Health Literacy、Nielsen-Bohlman, Lynn、Panzer, Allison M.、Kindig, David A.(2004)。Health Literacy: A Prescription to End Confusion。National Academies Press。  new window
圖書論文
1.Austin, N. M.(2003)。Process of splinting。Splinting the hand and upper extremity: Principles and process。Philadelphia, PA:Lippincott Williams & Wilkins。  new window
 
 
 
 
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