縮短心導管術前準備時間之專案

A Project on Reducing the Time for Pre-catheterization Preparation

目的：藉由跨單位溝通及流程整合方式，縮短心導管術前準備時間進而降低護理人員工作負荷及提昇照護品質。方法：於2012年11月1日至11月30日期間，於週日至週四入院預作心導管的病人，每日隨機抽1人共30人，由小組成員現場觀察紀錄一位由腹股溝接受心導管病人術前準備時間，平均共花費85分10秒。本專案以跨團隊溝通進行流程改造：（1）由主治醫師於門診給予病人同意書、（2）心導管室分二階段通知病人送心導管室、（3）主責醫護人員忙碌時啟動他組心臟內科住院醫師或專科護理師及護理師互助機制執行導尿管置入、（4）整合衛教單張及利用模型增加衛教成效、（5）相關單張統整定位及（6）修訂心導管術前檢核表等方案進行專案改善。結果：心導管術前準備時間由85分10秒下降至49分26秒，達目標設定值56.4分鐘（56分24秒）以下，共縮短35分44秒。結論：本專案旨在縮短心導管術前準備時間，透過流程整併、簡化及跨團隊溝通合作達成專案目的，確實縮短心導管術前準備時間及心導管室人員等待病人時間，且幫助病人在術前充分了解心導管檢查過程，減輕焦慮感，為本專案最大的貢獻。

Purposes: The purpose of this study is to shorten the time spent on pre-catheterization preparation and to lighten the nursing burden through multidisciplinary collaboration and integration. Methods: Before intervention, it took an average of 85 minutes and 10 seconds to prepare for cardiac catheterization (surveyed by questionnaire). To reduce the time spent, we adjusted our preparation protocol, including detailing the inform consent in the outpatient clinic and in the catheterization laboratory by visiting the staff, notifying the transport team and laboratory in advance, using education leaflets or models and modifying the nursing check-list. Results: The spent time in preparation was reduced from 85 minutes and 10 seconds to 49 minutes and 26 seconds (goal: less than 56 minutes and 24 seconds). 35 minutes and 44 seconds had been saved prior to the catheterization procedure. Conclusions: In this study, we integrated and simplified the procedure and emphasized multidisciplinary collaboration when preparing for cardiac catheterization. After these adjustments, the preparation and waiting times were greatly shortened. Furthermore, patients had a better understanding of the procedure before entering the catheterization laboratory.