提昇外科病房護理人員臨床預警系統「START」啟動率之改善專案

The Project to improve the Utilization Rate of “START” System by Nurses in Surgical Wards

背景：本院臨床預警系統「Shock Treatment And Resuscitation Team, START」於 2009年7月推行至外科病房，執行三個月後啟動率僅22%。目的：本專案的目的在於探討及分析系統啟動率低的原因，規劃改善措施以提升外科病房護理人員START系統啟動率。解決方案：本專案由2009年10月至2010年12月，發現護理人員啟動率低的原因為：（1）護理人員對非本科之多專科急症照護知識不足；（2）對START系統條件認知不足；（3）缺乏相關教育訓練及急症照護手冊。依據上述問題，專案小組擬訂解決方案：制定START追蹤學習單、外科急症照護手冊、安排教育訓練、組成小組讀書會及CPR技能演練稽核。結果：經三個月執行期專案介入後，護理人員急症照護知識由63.6分提升至80.5分，正確啟動START認知比率由68%提升至93%，START系統啟動率由原有的22%分別提升至評值期2010年4-6月的89%、7-12月的91%。外科病房非預期急救事件，也由2008年的6件下降至2010年的3件。結論：專案結果顯示介入措施能提升護理人員的多專科急症照護知識、提升START系統的啟動率，進而降低外科病房非預期急救事件。醫護人員足夠的認知是通報醫療事件成功的重要關鍵，START系統的設置是保障病人安全的重要機制。

Background: The START (Shock Treatment and Resuscitation Team) system was adopted to the surgical wards since July 2009. However, the utilization rate within the first three months was only 22%. Purpose: This project aims to analyze the underlying causes of low use rate of START system and to provide solutions to improve the utilization rate of START system by nurses in surgical wards. Resolution: The project was launched from October 1, 2009 to December 31, 2010. Two major reasons to induce low rate of using START system, including (1) Nurses knowledge with detecting patients’ early signs of emergency situation was insufficient, (2) lacking to advocate the policy, (3) lack of education and training and manual on emergency care. Based on the problems identified, strategies including preparing START education sheets and manual on surgical emergency care, arranging on-job education, holding study groups and practicing cardiopulmonary resuscitation skills, were taken. Results: The results showed: (1) Nurses knowledge in emergency care score was increased from 63.6 to 80.5, (2) the rate of knowing how to initiate START system was increased from 68% to 93%, (3) utilization rate of START system was increased from 22% to 89% from April to June, and 91% from July to December, 2010 respectively. The event of unexpected cardiopulmonary resuscitation was decreased from 6 in 2008 to 3 in 2010. Conclusion: The results showed that education interventions enhanced nurses’ knowledge in emergency care and capability in initiating START system and consequently reduced the event of unexpected resuscitation. The event of unexpected resuscitation was reduced by efficiently adopting START policy. Nurses with adequate knowledge play an important role in patient safety by using the START system.