提昇養護中心工作人員交班完整性

Strategies to Improve the Integrity of Hand-off among the Staffs in Caring Center

交班是長照機構照護過程中重要的一環。某養護中心因工作人員交班事項及流程繁雜，不了解對其他團隊照護情形，導致遺漏交班、疏忽及延誤回診等狀況，因此藉由本專案改善交班完整性。方法：本專案於2011年7月至11月間，使用以下三種方法實施：1.修改交班流程與細則；2.使用查檢表稽核交班人員交班完整性；3.以問卷進行滿意度調查。結果：35位參與交班人員（含護理人員、照顧服務員及社工人員），交班滿意度由56.5%提昇為92.6%；交班完整率：護理人員由64.9%提昇為88.2%，照顧服務員由35.9%提昇至88.4%，社工人員由34.9%提昇至63.8%。結論：經本專案發現交班不完整原因有：1.等待交班時間過久；2.環境吵雜；3.擔心工作無法如期完成；4.缺乏詳細交班流程；5.語言限制。藉由修改交班流程及細則、制定交班表單、製作海報及護理人員、社工、本國及越南籍照顧服務員交班提醒小卡並宣導交班流程，以提昇工作人員交班完整性及滿意度。

Providing a handoff report is one of the most important duties of care professionals based in long-term care centers. The integrity of hand-off reports has been shown to be compromised wing to lack of cordial relations between staff, complexity of the report process, and misunderstandings about other team members' duties. Forgetting to provide handoffs to workers in the next shift and handoffs with incomplete context result in delays in transferring residents to outpatient care. Therefore, the present study attempts to develop measures to improve the integrity of hand-off reports at a care center. Methods: This study contains three phases: 1. establishment of a standardized handoff report model, 2. evaluation of the integrity of handoffs before and after the implementation of this model, and 3. comparison of care providers' satisfaction levels before and after the implementation. The study was conducted from July 2011 to November 2011. Results: A total of 35 care staff were involved in this project, including nurses, social workers, and nurse assistants. The satisfactory rates were elevated from 56.5% to 92.6%. Clear improvements in the integrity of the handoff report were noted across all groups: nurses (from 64.9% to 88.2%), social workers (from 34.9% to 63.8%), and nurse assistants (from 35.9% to 88.4). Conclusion: During the course of this study, the following factors were identified as contributors to the compromised integrity of handoff reports: long waiting time to receive handoff reports, noisy work environment, worry about unfinished work, inadequate knowledge of the details of providing handoffs, and poor language skills. The following can be effective measures for increasing the integrity of handoffs: refining the flowchart for the handoff process, making the handoff report user-friendly, using reminder cards for staff (nurses, social workers, and domestic and foreign caregivers), and putting up posters to highlight the appropriate process for creating and structure of a handoff.