身心科住院病患配戴手圈以利辨識的問題之探討與對策

Wristband for Patient Identification in a Psychiatric Ward：A Research on Problems and Management

病患辨識是病房日常護理工作的首要。完備的病患辨識系統之運作，可避免患者發生不必要的傷害、意外甚或死亡。身心科的住院患者，由於認知力和注意力的減弱，在病患辨識方面比一般科病房較難施行。本院身心科病房以配戴手圈協助病患辨識，行之有年；不料，2004年的一項調查，顯示患者的配戴率低至20%。探查其因，發現「設備」、「流程」和「人為」方面均有缺失，分別各佔42.5%、31.5%與26.0%之因素。設備方面包括：「材質太硬、配戴不舒服」（17.1%）、「遇水後不具粘性」（15.8%）、「無法重覆使用」（9.6%）；流程方面包括：「未告知何時配戴」（13.7%）、「未明訂查核時間與方式」（12.3%）、「未說明需要配戴」（5.5%）；人為方面分為「顧客」（病患與家屬）與「護理」2大項，前者包含：「不明白配戴的重要性」（11.0%）、「病患不具充分認知能力」（2.1%），後者則包含：「不知配戴的重要性」（6.8%）、「未重覆核對」（3.4%）、「自認與患者熟識」（2.7%）。「工欲善其事，必先利其器」，我們首先改變手圈的結構。接著重新設計考核稽查的流程，推行床邊病患/家屬的教育工作；並藉循流不息的護理宣導、教育與訓練，來提昇護理人員的認知。從本案的探討、規劃、試行、檢討與實施的過程中，我們再次體驗了「全面品質經營」在日常護理工作中的必要性。而其結果，讓病患與家屬對手圈配戴的「顧客滿意度」，從41.4%提升到85.6%；手圈配戴率，也由原來的20%提升到85%以上。

The patient identification system had to be comprehensive enough yet delicate enough to prevent any unreasonable accident, injury or even death of patients. It is hence very important to involve such a complete identification system in the daily nursing activity in a ward, especially the psychiatric ward, in which the patients admitted usually have a lower cognition and comprehension ability than those admitted in the non-psychiatric wards. For years, the wristbands were used for patient identification in our psychiatric ward, though there was a very low putting-on rate, for example a putting-on rate of 20% during May 2004 in the present study. We subsequently conducted the study to search the causative factors leading to the low putting-on rate of wristbands, and found out there were 3 major items including those from the disadvantages of equipment (42.5%), those from the management procedure (31.5%), and those from persons´ misunderstanding/mistake (26.0%). In the equipment disadvantages were “hardware causing discomfort for putting-on” (17.1%), “loss of adhesion if being wet”(15.8%), and “not easy for repeated use”(9.6%). In the management procedures were “no statement for when to putting-on”(13.7%), “no recheck system”(12.3%), and “no statement for needing get it on”(5.5%). The “customers” (the patients and/or their family) and the nurses shared equal responsibility for persons’ misunderstandings/mistakes, respectively 13.1% and 12.9%. A certain portion of the customers were “unaware of the necessity to put it on”(11.0%), and still few of the customers had “no cognition/comprehension for putting it on”(2.1%). Finally, possibly the most important ones, a certain portion of the nurses were lacking in some acknowledgments, as “unawareness of the importance for a patient putting on a wristband”(6.8%), “unawareness for repeated check-out”(3.4%), and “misconception of relationship between the nurse and the patient”(2.7%). In order to elevate the patients´putting-on rate of wristbands, and to improve the patient-identification system, we first refined the wristband’s construction (for detail, please see text). Then, we re-designed the managing processes through the PDCA (plan-do-check-action)-to-SDCA (standard-do-check-action) principle, including a repetitious checkout circle, a bedside instruction/persuading system for the patients and family, and a repeating education/training course for the nurses. With all the above enforcement and encouragement, the customers’ satisfaction of the usage of wristbands shifted from 41.4% to 85.6%; and the putting-on rate of wristbands was elevated from 20% to 85%. And, to the most important, we once more recognized the benefits of the improvement of the daily patient-care activity through the “total quality management”system.