建構手術室病人安全照護作業模式－－以手術病人辨識、部位、程序安全為例

The patient safety care model construction in the operating room-an examples for patient identification, surgical site, application security procedure

目的：本專案是透過自我重新檢視手術單位安全相關作業程序，整合共識建立手術安全標準化查檢流程，達到手術團隊共同嚴格把關每個查核點環節。方法：建立手術室醫療人員實施手術病人身分、部位及程序之手術查檢表；評值手術室醫療人員使用「手術室安全查檢表」的臨床成效。結果：制定手術室病人安全標準化，建置醫療資訊系統整合之術式訊息傳遞流程，手術查檢表執行率由45.0%提升至100%，且於前段術前查核作業即時發現查檢表錯誤率由3.3%下降0%。結論：整體而言，對每一道程序及交接作業都能謹慎、確實執行，為手術病人「安全」把關，提供完善的作業程序將醫療風險降至最低保障患者安全，杜絕其錯誤發生，將查檢結果成效提供他院參考，作為醫療品質改進參考。

Purpose: This project involved spontaneous re-examination of related safety operating procedures at surgical units in order to create a standardized inspection procedure for surgical safety based on shared opinions so that the surgical team could jointly check each inspection point strictly. Methods: The surgery checklist for the identity of a specific patient and the surgical site and procedure involved was created for healthcare professionals in the operating room. The clinical efficacy in OR healthcare professionals' use of the OR Safety Checklist was evaluated. Results: Patient safety was standardized in the operating room and a medical information system integrating the information relay process within the OR was created. The implementation rate of the surgical checklist increased from 45.0% to 100%. In addition, the error rate found in the checklist from the pre-operative inspection process dropped from 3.3% to 0%. Conclusion: Generally speaking, when each procedure and handover process is carefully and precisely implemented to keep surgical patients 〞safe〞, the perfect operating procedure will minimize medical risk to protect patients' safety and eradicate errors. The inspection results and efficacy can also be provided to other hospitals for reference while improving quality of medical care.