運用團隊資源管理工具（Team Resource Management, TRM）提升成人加護病房病人安全風氣及照護品質

Use of Team Resource Management Technique to Improve Safety Climate and Care Quality in an Adult Intensive Care Unit

前言：運用航空界的組員資源管理訓練可提升單位病人安全文化、增加病人安全與降低錯誤發生。材料與方法：以跨團隊模式組成改善團隊於成人加護病房進行改善，包括訂定需執行事前說明項目；每日三班交接班時間執行人員關懷活動；建立結構化ISBAR交班表模式。結果：參與訓練後學員們病人安全態度有很正向改變，23題人因態度問卷中有21題達統計上顯著意義，而在病人安全文化量表的部份，六個構面皆有提升；對策實施後，執行事前說明及事後檢討比率由12.5%提升至81.3%；人員關懷活動每日執行率達100%；ISBAR交班執行率由59.42%提升至93.46%；異常事件通報率由0.14%提升至0.32%；感染密度則由千分之13.3降低至千分之10.2；非計劃性氣管內管滑脫率由0.209%降至0.063%，各項指標皆有顯著改變。結論：未來將持續進行追蹤分析及檢討，建議醫療院所應及早導入團隊訓練，幫助醫療照護團隊對於病人照護發揮更大的效益與成效，降低犯錯機會及促進病人安全。

Background: The implementation of aviation crew resource management technique can reduce medical error by improving safety climate and care quality.Materials and Methods: We organized a quality improvement team in an adult intensive care unit. The interventions, including: briefing, employee care, and structural handover programs (ISBAR- I, situation, background, assessment, recommendation) were implemented.Results: The safety climate in the unit significantly improved. The unplanned extubation rates drop from 0.209% to 0.063%; and the incident reporting rates increased from 0.14% to 0.32%, but the event severity reduced significantly. The completion of ISBAR handover rates improved from 59.42% to 93.46%.Conclusion: We will continue to monitor and analyze the outcomes. We suggest early implementation of team technique to improve safety climate and care quality.