某醫院外科病房以臨床照護品質為導向之改善專案－－以某醫院之外科病房為例

A Clinical Nursing Quality- Oriented Performance Improvement Project

本專案係針對外科病房以臨床照護品質為導向的改善為主，而照護品質之提升有賴於護理人員的專科技能加強。其目的在提供病患一個安全、專業的環境使降低抱怨。改善前，由督導進行問卷調查（40份），經由分析發現，外科照護品質降低之原因：醫師未能定時查房（90％）括)護理人員專業知識技能不熟悉（73.3％）病房未專科化（60％）等，故針對此三項進行改善。採不預警測試外科40位護理人員，測試內容包括外科病房常見疾病護理、手術方式等。經40分鐘測試後，平均成績為52分，改善後，再次測試成績為84.5分，為有效提高護理人員的專業知識，再依護理標準作業流程（SOP）來學習，由護理長再次進行測試，其成績均能達到100分。至於主治醫師未定時查房，則先與他們溝通，取得共同認可的時間，並製成查房時間表置放於工作車上，隨時讓護理人員能順利回答：實施一個月後，再次問卷調查住院中45位病患或家屬，結果病患抱怨率由22％降到8.8％，抱怨醫師未定時查房的比率由90％降到36％。然外科護理人員專業臨床照護品質的提昇，仍有賴於人員均能依照護理部制訂各項標準作業流程來執行。若每位同仁都能正確執行臨床所有照護工作，對提升專業照護品質是有實質的幫助。This case study focused on the quality performance improvement in clinical surgical nursing. The purpose of quality performance improvement was to provide a safe patient care environment to reduce patients' complaints；this was done through enhancement of professional nursing knowledge and skills. About 40 patients or families received survey questionnaires before implementation of an improvement project. The barriers to quality nursing care were identified:patients or families lacked information regarding physicians' visiting hours (90%),nurses failed to update professional knowledge and skills(73.3％),and the ward was not designed for disease-specific diagnostics(60%),etc.41 surgical nurses were tested for 40 minutes of their nursing knowledge and skills without being informed in advance. The test contents included common diagnostic diseases in the surgical area, surgical types, etc. The pre-test score showed that an average of 52. After an improvement project was implemented, the post-test score was up to 84.5. In order to increase nurses' professional knowledge, standards of procedures (SOP)were reinforced. The test score was continuously raised to 100. Through communication with physicians, nurses also received schedules containing the physicians' visiting hours. One month after the implementation of the project, 45 patients or patients families received a survey. The results showed that patient complaints decreased from 22% to 8.8%；the complaints regarding physicians' visiting schedules decreased from 90% to 36%. Increasing professional nursing quality in the surgical area depends on the individual nurse's performance by following the SOP. If every nursing colleague can accurately perform each nursing skill, the quality of professional nursing can increase.