北部某醫學中心外傷加護病房計價完整性改善方案

Improvement Approach for Charge Completeness at a Trauma Intensive Care Unit in a Medical Center

本專案目的為外傷加護病房護理人員執行計價完整性及計價認知程度之瞭解與改善，以提升護理人員計價之完整性。現況中發現計價完整性方面，治療處置項目的計價完整性為78.75％，材料項目的計價完整性為94.79％，顯示計價完整性仍有待提升；就本專案現況調查結果得知，護理人員對於計價的認知為67.8％，顯示護理人員在計價的認知程度仍有改善的空間。因此，綜合以上缺失，進行本專案之改善方案：（一）因治療處置及材料項目皆需進行改善，故設計計價輔助工具，以提升護理人員計價之完整性，包括：「單位常用處置及處置內容物標示」、「處置包計價作業隨身小卡」、及「橡皮章」，提供臨床護理人員正確計價之指引。（二）建立單位教育與個別指導的制度，加強護理人員正確的計價認知。經過本專案改善後，計價完整性方面，治療處置計價完整性由改善前的78.75％提高為95.38％，材料項目計價完整性由改善前的94.79%提高為97.63%，且達統計上顯著差異；護理人員在計價之認知由改善前的67.8%提高為95.9%，且達統計上顯著差異。因此，透過此專案的改善後，提升護理人員對正確計價的認知，提高臨床計價的完整性。

The purpose of the project was to improve the completeness of charge and knowledge about charge of nurses at the trauma intensive care unit. Before the improvement program, the charge completeness for treatment management and material was 78.75% and 94.79%, respectively, indicating the insufficiency of charge completeness. The overall knowledge about charge was 67.8%, indicating that the level of knowledge also needed to be improved. After analyzing the current status, the improvement approaches included: (1) establishment of charge assisting tools, including the label for regular management, charge portable card of management package, and rubber stamp; (2) organization of a systematic unit education and individual direction program. After the improvement program, the charge completeness for treatment had improved from 78.75% to 95.08%, and the charge completeness for materials had improved from 94.79% to 97.63%. The nurses’ knowledge about charge had improved from 67.8% to 95.9%. The program not only improved the nurses’ knowledge about charge but also promoted charge completeness.