提升血液透析前病人跨部門交班完整性專案

A project to improve the integrity of inter-departmental shift handovers for patients in pre-dialysis

醫策會自 2004 年迄今將「提升醫療照護人員間溝通的有效性」列為病人安全目標。本單位為腎臟科病房，血液透析病人平均 500人次／月，病房與血液透析室進行跨部門交班作業，因：（一）血液透析前交班完整性低：1. 血液透析前交班項目完整性為 76.9％。2. 血液透析前準備用物完整性為 80.7％。3. 病人送檢透析室延遲率為13.9％。（二）護理人員執行血液透析前交班滿意度僅達 63.3％。（三）血液透析前護理交班資訊系統操作工時需耗費 10.8 分鐘／件，透過跨部門整合交班流程、整合透析前交班系統，修訂跨部門交班作業規範，與透析室達成共識，建構部門間交班作業標準化及跨單位間溝通機制，提升透析前交班完整率達 95％ 及病人至透析室延遲率降低為 3.9％，操作工時節省 6.3 分，護理人員對交班流程滿意度達 90％。因此，交班方案能改善交班問題，提昇護理品質。

"In 2004, “Promoting the effectiveness of communication among health care professionals” was declared as a goal of patient safety by the Taiwan Joint Commission on Hospital Accreditation. This project was implemented in a nephrology ward that handled 500 hemodialysis sessions each month. Nurses at the nephrology ward encountered several problems during shift handovers of patients to the hemodialysis center. 1. Integrity of shift handover preparation before hemodialysis was low in the: (1) preparation of documentation (76.9%); (2) preparation of materials or supply (80.7%); (3) the patients arrive the hemodialysis center was delayed (13.9%). 2. Nursing personnel’s satisfaction shift handover before hemodialysis was just 63.3%. 3. The information system for shift handover of patients in pre-dialysis took 10.8 minutes per case. For this project, the authors worked with the nursing staff of the hemodialysis center to standardize the inter-department shift handover procedure and inter-unit communications mechanism. The improvements increased the integrity of pre-dialysis shift handover to 95%, decreased the rate of delayed patient transfers to the hemodialysis center to 3.9%, shortened processing time by 6.3 minutes and increased nursing staff's satisfaction with the shift handover process to 90%. The shift handover project was therefore effective in correcting shift handover problems and enhancing the quality of care."