運用團隊資源管理(TRM)建構醫護訊息傳遞之溝通模式專案

Team resource management strategy on Developing a Communication Model of Message Delivery Between Doctors and Nurses

台灣病人安全通報系統年報中指出因「溝通因素」所產生之病人安全事件中，以醫護團隊間溝通不足所佔比例最高。而隨著跨領域合作及團隊合作之推廣，可提升溝通有效性，且逐漸受到各醫療機構重視。個案醫院分析造成該院醫護同仁訊息傳遞不完整原因為：醫護訊息傳遞機制不足、護理師接受訊息太多且不一致、未落實口頭訊息登記、醫護專業評估能力不完整。本專案乃藉由團隊資源管理工具及品管圖手法，組成團隊並由醫療科擔任領導統馭角色、藉團隊的警覺應變、互助合作及加強溝通技巧執行改善，進而提升醫護間訊息傳遞，強化病人安全。專案成員擬定具體改善方案包括：運用TRM「領導（Leadership）」手法，規範住院病人醫護一同查房對象：運用「守望、相助」，設計評估卡，作為醫護評估及溝通備忘錄；運用「溝通ISBAR交班」制訂訊息傳遞規範，修訂口頭訊息本使用規範及管考機制；最後落實紀錄及追蹤。運用TRM整合醫護訊息傳遞溝通模式，使醫護團隊訊息正確。評值結果：醫護訊息傳遞不完整率由70%降為14%，滿意度由50%增加為86.7%，精省不良事件導致聯繫處理時間成本約602,700元。推動醫護共同訊息交換機制，設定「住院病人查房作業流程」及「醫護共同評估卡」4項，並列入標準化。希望藉本專案全院推廣， 並分享其他醫療團隊，提昇醫護關係，增進整體照護品質及病人安全。

Based on the database of Taiwan patient-safety reporting system, the concept of interprofessional practice and teamwork is becoming popular and healthcare organizations are gradually emphasizing. A preliminary study at our hospital showed there were 4 main reasons leading to cause incomplete communication: lack of communication system between doctors and nurses, too many discordant messages, not write down the messages, and inability to write a complete health assessment. In this project, we introduced team resource management (TRM) process and quality control circle (QCC) to improve the communication efficiency and promote patient-safety. Using the “TRM leadership” approach, we standardized which kinds of inpatients that ward staff member need to cooperate to care for and developed communication cards to remind staff member of their patient’s conditions. We also used the “ISBAR” approach to standardize content reported on shift papers. Together these solutions, which were introduced and followed up improved communication efficiency. Percentage of incomplete message deliveries decreased from 70% to 14% and the staff satisfaction increased from 50% to 86.7%. In addition, it saved about NT$602,700 because clinical staff member spent less time on dealing with incomplete message deliveries.By sharing our experience with this project with other medical teams, we hope that the relationships between clinical doctors and nurses, healthcare quality and patient-safety can be improved.