手術室器械遺失調查及其相關影響因素之探討

Investigation on the instrument losses and their risk factors in an operating room setting

器械遺失不但增加醫院的成本，對醫師與病人都造成極大的影響。本研究旨在 調查某醫學中心醫院手術室器械使用與遺失情形，並分析手術室器械遺失影響因素， 增加器械管理相關研究之佐證文獻。研究採前瞻性調查法，並利用亂數表抽選出每天 15 台手術房之號碼，使用問卷調查表於95 年3 月至96 年6 月分兩階段收案方式， 其中經過四個月的改善期，共收案2,963 份；統計方法採用卡方檢定分析與T 檢定分 析進行組間比較，最後以邏輯斯迴歸分析瞭解器械遺失之影響因素。研究結果發現器 械遺失率平均為1.1%，而影響器械遺失相關危險因素包括器械包內容的完整性（odds ratio=76, P=0.000）及刷手護士是否交接班（odds ratio=2.17, P=0.07）。建立持續品質改 善的管理理念、落實交接班與跨班別管理、定期檢查器械包內容完整性與器械卡正確 性，相信如此一定能使未來器械遺失率趨近於零，進而降低醫院購置器械的成本，提 昇手術室的服務品質與病人安全。

Instrument loss not only increases hospital cost, but also has great impact on surgeons and patients in operating room. The objective of this study is to investigate the instrument loss and to analyze the factors that may affect the instrument loss in a medical center with aim to provide relevant data for instrument management. Study was performed in a prospective manner using random table to sample 15 operations every day. The survey form was given in a 2-stage fashion from March 2006 to June 2007, including four months implementation of quality improvement method. A total of 2, 963 operations were enrolled. Statistic methods using Chi-squared test and T-test were applied to compare within groups. Risk factors on instrument loss were analyzed using logistic regression analysis. It is found that average instrument missing rate was 1.1%. The factors that affect instrument loss included: instrument package completeness (odds ratio=76, P=0.000), and complete surgery nurses handover (odds ratio=2.17, P=0.07). The study shows that the introduction of continuous quality improvement management, handover improvement, regular instrument package inspection, and the instrument card correction can significantly reduce instrument loss rate to zero. We believe this can further contain the hospital instrument cost to enhance operation room service quality and patient safety.