提昇膝關節鏡手術護理指導之執行率改善方案

Knee surgeIy to Enhance the Implementation Rate about the Improvement of Nursing Instruction Program

本專案旨在提昇護理人員膝關節鏡手術護理指導執行率。經現況分析、回溯性病歷審查及訪談方式，瞭解本單位膝關節鏡手術護理指導執行率僅68.5％；依據本院資管部資料統計發現，本單位自2008年4月1日至6月30日行膝關節鏡手術共有54人次，平均住院天數4.83天、醫療費用31，043元、護理指導執行率68.52％。其原因為：缺乏作業標準流程、缺乏診療共識、護理人員未執行護理指導、自覺認知不足、缺乏照護指引規範、缺乏標準作業流程、護理指導單張種類不足等等問題。經由文獻查證並與專科主治醫師討論後，擬訂製作護理指導單張、臨床路徑表單，經在職教育宣導後，實施稽核、品質監控方案介入後，使膝關節鏡手術護理指導執行率達98.5％、平均住院天數降至3.73天、醫療費用降為22，834元，達到提昇護理照顧品質之最終目的。The aim of this project was to improve the administration rate of nursing instruction for patients who underwent knee arthroscopic surgery. 54-patient data collected retrospectively from the department of Information Management Office from April to June 2008 revealed that the average length-of-stay was 4.83 days; the medical expenditure was 31, 043 NT dollars; and the administration rate of nursing instruction was only 68.52%. Through data analysis and interviews, the reasons for the low administration rates were as follows: 1) Lack of a standardized procedure for caring the patients with knee arthroscopic surgery. 2) Lack of treatment consensus. 3) Nursing staff not providing nursing instruction or feeling a lack of knowledge. 4) Lack of guidelines for clinical care. 5) The insufficiency of educational materials. Through literature review and discussion with specialist physician, we developed nursing instruction sheets and clinical pathway of knee arthroscopic surgery, provided on-the-job training for nursing staff and continuously monitored the administration rate of nursing instruction. After this project, the administration rate of nursing instruction increased from 68.5% to 98.5%; the average length-of-stay decreased from 4.83 days to 3.73 days; and the medical expenditure was also reduced to 22, 834 NT dollars. This project not only increased the administration rate of nursing instruction but also improved the quality of care.