導入團隊資源管理對加護單位病人安全文化之影響

The Impact on Patient Safety Culture in the Intensive Care Unit Using Term Resource Management

以醫院評鑑暨醫療品質策進會的中文版「醫療機構病人安全態度量表」，對某區域醫院加護單位的醫護人員進行前測，發現在「跨單位團隊合作」及「交接班」的正向回答百分比為最低的兩項，因此導入團隊資源管理（Team Resource Management, TRM）模式的介入措施，將「事前說明（brief）、事中檢視（huddle）及事後檢討（debrief）」的技巧應用於「跨單位團隊合作」的「氣管插管病人的送檢」，將「病況（situation）、病史（background）、評估（assessment）及建議（recommendation）；SBAR」的技巧應用於「交接班」及「病況的說明」。全程使用查核表來考核執行的完整性，針對遺漏的項目當場立即提醒並且改善。實施一年後，再進行後測，結果發現TRM導入後（樣本數116人）比導入前（樣本數113人）醫護人員的正向回答百分比平均高出11.4個百分點。在正向回答分數，包括「團隊合作」（71.4 v.s. 66.4）、「單位安全的風氣」（68.9 v.s. 61.7）、「對工作的滿意」（63.5 v.s. 52.8）、「對管理的感受」（66.3 v.s. 58.1）、「工作狀況」（68.6 v.s. 58.5）、「醫院管理支持病安活動」（63 v.s. 56.1）、「跨單位團隊合作」（62.1 v.s. 55.7）、「交接班」（53.7 v.s. 45.6），皆有顯著的增加（p＜0.05）。本研究結果支持在加護病房導入TRM模式的介入措施，可以全面提升病人安全文化，在加護病房適合使用「事前說明（brief）、事中檢視（huddle）及事後檢討（debrief）」及SBAR做為團隊溝通的方式。

A Chinese version of the Patient Safety Attitude Questionnaire developed by the Taiwan Joint Commission on Hospital Accreditation was conducted to measure the healthcare workers' attitudes toward patient safety before (N=113) and after (N=116) a year of using Team Resource Management (TRM) in the intensive care unit (ICU) at a regional hospital. The lowest two percent-positive scores were found in ”teamwork across hospital units” and ”hospital handoffs & transitions” dimension before using TRM. The skills of TRM including ”brief, huddle, and debrief” and ”SBAR (situation, background, assessment, and recommendation)” were started in the ”shift of endotracheal tube intubated patient” and ”information transfer”, respectively. Real time auditing with checklist and feedback to healthcare workers were performed at the same time. After one year of using TRM, the average percent-positive score increased 11.4%. The positive score increased significantly (p＜0.05) in the dimensions of ”teamwork climate” (71.4 v.s. 66.4), ”safety climate” (68.9 v.s. 61.7), ”job satisfaction” (63.5 v.s. 52.8), ”perception of management” (66.3 v.s. 58.1), ”working condition” (68.6 v.s. 58.5), ”hospital management support for patient safety” (63 v.s. 56.1), ”teamwork across hospital units” (62.1 v.s. 55.7), and ”hospital handoffs & transitions” (53.7 v.s. 45.6). In this study, the result supported that patient safety culture in the intensive care unit can be elevated by using TRM. The skills of ”brief, huddle, and debrief” and ”SBAR” were more effective in managing communication in the ICU.