手術前之暫停查核機制降低手術部位感染率

如何確保及提升病人就醫安全是醫院一直努力的方向，也是新制醫院評鑑除了持續提升醫療品質外的另一主軸。手術室是整個醫院中進行侵入性治療最頻繁的單位；然而，根據2008 年世界衛生組織（WHO）指出，發生在醫院中的醫療不良事件有一半跟手術室作業有關，而其中一半以上是可能加以避免的。手術室工作牽涉的成員相當複雜，包括手術醫師、助手、手術室刷手及巡迴護理師、麻醉科醫師及麻醉護理師等，整個手術作業需要團隊成員間密切合作，但只要是人就可能犯錯，而一個團隊成員的錯誤就可能造成手術相關的醫療不良事件。因此如何透過系統性、制度化的模式來避免手術相關的不良事件是各醫療院所持續努力的目標。研究醫院於2009 年4 月開始全面導入世界衛生組織手術安全查核單（WHO surgical safety checklist）及實施手術劃刀前的暫停（time out）機制，經實施一年後，統計分析發現能有效降低手術傷口感染率，同時能避免如手術部位錯誤，紗布、縫針或器械遺留體內或手術標本錯誤之情形，在此提出研究醫院之經驗及結果分析報告，希望提供國內其他醫院參考。

All the hospitals concern the patient safety. It is well known that the majority of medical errors take place in the operation room, where the working members include surgeons, anesthesiologists, assistants and nurses. The communication between these workers is important to prevent the surgical errors. The surgical time-out and safety checklist are aimed to prevent wrong-site, wrong-procedure, and wrong-person surgeries. Currently, the safety checklist of our institute consists of a preoperative verification, marking of the surgical site, and a time-out before starting the operation. The surgical time-out before incision has also been recognized as an opportunity to improve communication among surgical team members, and to reduce infection or mortality rate. Furthermore, formal checklists have also been added to this process to improve surgical quality. However, how effective that implementation of the surgical time-out and checklist will be in preventing patient harm is not well studied in Taiwan. Here in, we reported the results of this implementation of these methods in the patients of our hospital. Based on our results at one year follow-up, we demonstrated the surgical site infection rate was reduced and we prevented wrong procedure of laterality, mislabeled specimen and any retained medical devices including needles or sponge.