運用團隊資源管理提升全身麻醉術後病人之體溫

Applying Team Resource Management to Accelerate Rewarming Among Patients Undergoing General Anesthesia

背景術後低體溫會使病人麻醉甦醒延遲，或甦醒過程中因顫抖而感到不適，增加身體耗氧量、增加手術傷口感染及合併症發生的機會。調查本單位全身麻醉術後病人體溫回升之現況發現，病人入恢復室第60分鐘後體溫 ≥ 36℃僅佔74%。分析原因包括：保暖設備不足、缺乏標準流程與稽核制度、護理人員對低體溫認知不足，以及醫護團隊於手術全期未做好保暖措施。目的本專案目的為運用團隊資源管理，提升全身麻醉術後病人體溫在進入恢復室第60分鐘，體溫達36.0℃比率由74%提升至100%。解決方案本專案透過建立保暖標準作業流程、定期稽核、增加保暖設備、舉辦在職教育，及運用團隊資源管理與手術室護理人員共同執行保暖計畫，以提昇全身麻醉術後病人之體溫。結果病人入恢復室第60分鐘後體溫 ≥ 36℃的比率由74%提升至100%。結論本專案執行成果顯示，跨團隊合作可有效提升全身麻醉術後病人低體溫之改善，進而增加麻醉手術後之照護品質。

Background & Problems: Hypothermia is the cause of multiple problems such as delayed awaking from anesthesia, feelings of discomfort, increased oxygen consumption, and increased risks of surgical wound infection and complications. A review of the record of post-operative patients receiving general anesthesia (GA) revealed that only 74% of the patients in our post-anesthesia room (PAR) had restored their body temperature to 36℃ after 60 minutes. Through situation analysis, several causes were identified, including insufficient warming facilities, lack of standard procedures and an audit system, lack of knowledge regarding hyperthermia among nurses, and the incompleteness of perioperative warming interventions performed by the healthcare team. Purpose: The aim of the present project was to apply team resource management (TRM) to raise the rate of body temperature restoration to 36℃ after 60 minutes in our post-anesthesia room (PAR) from 74% to 100%. Resolution: Several strategies were implemented to accelerate the post-operative rewarming for patients receiving GA, including: establishment of standard operating procedures for warming, conducting routine audits, purchasing warming facilities, conducting in-service education, applying TRM, and cooperating with nurses in operating rooms on executing the warming plan. Result: After implementing these strategies, our PAR achieved a 100% success rate in raising the body temperature of postoperative patients to 36℃ after 60 minutes. Conclusions: The result demonstrates that hypothermia may be effectively avoided and that the quality of post-operative care may be effectively improved through transdisciplinary teamwork.