運用團隊資源管理建置病房交班制度

Applying Team Resource Management to Establish Ward Hand-off System

交接班一旦不夠正確完整，病人後續醫療照護將因不完整而延誤病情。ISBAR 是一種標準化、簡潔、完整清楚、容易明白、及時提供資訊的溝通模式，以ISBAR 原則制/修訂單位內交班標準及交班表等方式，不只能改善單位內交班制度，在提升交接班品質更有正面影響。然以交接班正確性及完整性來代表醫療照護團隊交接班品質之良窳，恐怕不足，須再監測病人後續醫療照護上之交接班內容一致性與發生非預期性事件之比率及頻率，特別是在病人發生非預期性事件原因上的探討，才能真正保障病人安全。第一線執行交班單位與後線接班單位病人安全文化調查前後測呈現不同結果，這或許與實施相關對策後，對交接班安全認知有更整體且更深一層的體會有關，值得後續再進一步深究探討。

Once the handoff is neither accurate nor complete, it may delay patient's further care due to incompleteness. ISBAR is a standardized, concise, and easy to understand mode of communication for handoffs. Using the principles of ISBAR, not only improves communication within the unit, but also has a positive impact on promoting its quality. The assessment of the quality of a medical team by monitoring the accuracy and completeness of handoffs may not be sufficient. Additional monitoring should include the consistency of its content, as well as the proportion and frequency of occurrence of unexpected adverse events. Further in depth discussion and realizing the causality of such events are more important factors that guarantee patient safety. After the implementation of a new handoff system, we noted that there was a before and after difference in the results of survey on patient safety culture. It is possible that during the process of its implementation, medical and nursing staff had a higher and more complete awareness with regards to the overall importance of handoffs and patient safety issues. However, the true nature such results warrants further investigation.