縮短急診毒蛇咬傷病人施打抗蛇毒血清等待時間之改善方案

An Improvement Project for Patients with Viper Bite to Receive Serum

把握時效使用抗蛇毒血清是治療毒蛇咬傷的重要步驟，但據本院急診室統計資料顯示，較台北榮民總醫院毒藥物諮詢中心規範最好在30分鐘內施注血清之建議明顯偏高許多，透過查檢及統計分析發現原因為：一、缺乏毒蛇咬傷處置照護教育訓練；二、未制定毒蛇咬傷照護之標準流程；三、沒有清楚明顯毒蛇圖片提供病人辨識等。經專案設計擬定解決辦法為：一、提供教育訓練；二、制定毒蛇咬傷病患照護標準手冊；三、提供清楚明顯的毒蛇圖片以供病人辨識。經實施改善措施後，將等待施打血清時間由65.2分鐘降至32.4分鐘，雖未達設定目標值，但有顯著下降，且目標達成率為93%，品質改善率為50.3%。顯示本專案的執行成效，建議可以將此推廣至其他醫療院所或社區情境，以改善民眾被毒蛇咬傷後的治療效率。

Immediately receiving antivenins is an important step in the treatment of snake bites. However, based on the data from the emergency department of the hospital, the waiting time for antivenins was much longer than 30 minutes, which is the time recommended by the Taiwan National Poison Control Center of Taipei Veterans General Hospital. Through the investigation and analysis, the following reasons were found: 1. There was insufficient nursing education on handling snake bite wounds. 2. The standard manual for nursing care of snake bite patients has not been established. 3. There was no clear and obvious viper picture for patients to distinguish. In the scheme, the following solutions were designed: 1. Provide training. 2. Establish the standard manual for nursing care of snake bite patients. 3. Provide clear and obvious viper pictures for distinguishing. Since the improving measures have been implemented, the waiting time for applying antivenins has been reduced from 65.2 minutes to 32.4 minutes. Although it still did not meet the target criteria, the waiting time was reduced significantly. The target-achieving rate was 93% and the quality-improving rate was 50.3%. The effect of the improvement scheme was confirmed in the project. It provides strong evidence for applying the scheme to other hospitals and to the community setting.