外科病房交班內容完整性之改善專案

A Project to Improve the Completeness of Nursing Shift Reports in the Surgical Ward

本外科病房發現交班內容未達80%完整率之項目，佔所有項目之29.4%，經現況分析，確立問題為：單位同仁不瞭解交班應具備之內容、現行交班標準不適用、病人交班內容欠缺專科之特殊知識與指導及個案分配未顧及連續性；經修訂交班標準、進行教育訓練及改變排班方式之改善策略執行後，結果顯示：所有項目皆達80%之完整率，故本專案之目標達成。在執行過程中發現：全員參與及成員缺乏自信是專案執行的助力及阻力，由於單位之工作性質不同，此方法無法推展至非外科病房是本專案限制。此專案之實施方法，已正式納入本單位新進人員訓練中，建議學校可將交班應具備之內容、技巧及原則，安排於教學課程中；未來之研究則可朝影響交班內容之完整性之因素，作深入探討。

The authors found that surgical ward shift reports were not being adequately completed, with 29.4% of content items on shift reports not reaching 80% completeness. After an analysis of the situation, we found that the problems were caused by factors that included lack of understanding of shift report contents, inappropriate shift reporting standards, lack of specialty-related knowledge and guidance in the shift report, and discontinuities in patient care allocation. Based on these findings, the researchers revised shift-reporting standards, redesigned the report format, conducted relevant training, and changed the shift assignment methodology. A survey conducted following implementation of researcher-directed changes found that 100% shift report items had reached 80% completeness and achieved improvement goals. At the same time, the author found full staff participation and lack of confidence to be, respectively, the principal strength and weakness in accomplishing this project. A limitation of this project is that it cannot be applied to non-surgical wards. Project methods have already been applied to new staff training in the hospital at which this study was conducted. Based on project findings and experience, the author also makes the following additional suggestions: (1) shift report-related content, skills and principles should be incorporated into school curricula; (2) shift report should be monitored and updated regularly; and (3) follow-on research may explore the factors that affect shift report content completeness.