新生兒預防保健在院完成聽力篩檢之研究

Study of neonatal preventive health care in hospital

兒童健康是國民健康的基礎，也是國家未來發展的棟樑，更是父母及政府的責任，尤其是在現今出生嬰兒數量的下降趨勢下，更應著重其兒童健康發展。行政院衛生署國民健康局於2012年3月15日全面實施新生兒聽力篩檢補助，以提升兒童預防保健的服務品質。主要目的就是藉由兒童健康問題的篩檢，早期發現潛在性的健康問題，進而提供連續性的治療，以達到早期預防、早期治療之效。而在現今醫療院所均有限之人力及資源下，應如何推行有效率且符合成本效益的新生兒聽力篩檢，並提升出生新生兒在院完成率指標，減少聽損兒及其家屬之焦慮感、提早治療的時間，是本研究的主題。本文以HFMEA方法，進行狀況分析、繪製流程圖、危害分析、決策樹分析等步驟，擬定改善對策，進行成效評估。本研究執行成效如下：1.改善新生兒聽力篩檢在院完成率，由104年51%提升至106年1~2月92.7%。2.將醫療人員溝通平台E化，改善醫療單位與護理單位聯繫困境，而醫護人員利用E化聯繫率於105年7~9月皆達100%。3.利用在職教育以強化護理人員於新生兒聽力篩檢的知能。4.落實新生兒家屬參與程度，以互動性討論方式來修訂未完成聽力篩檢通知書，改善門診新生兒聽力篩檢到檢率，由104年65.6%提高至106年1~2月100%。本文推論以HFMEA品管方法可有效率地分析及協助解決複雜的醫療流程，提升在院檢查完成率之目標，並提供全國醫療院所參考，嘉惠更多新生兒，建立一個以病人安全為中心的醫療環境。

Child health is not only the foundation of national health, but also the national future pillar of the state development, as well as the responsibility of the parents and governments. In view of the decreased population of newborn in recent years, it should be more focused on the development of child health. On March 15th, 2012, Bureau of Health Promotion, Department of Health, Executive Yuan comprehensively put newborn hearing screening subsidies into practice to enhance the service quality of children prevention and healthcare. The objective of the policy was to discover the potential health problem in the early stages and provide the continuous treatments to achieve the impression of early prevention, early treatment. Thus, the topic of this study was to investigate the strategy for the implementation of newborn hearing screening with efficiency and cost benefit, and increase the index of newborn finish rate in hospital, decrease the anxiety of hearing-impaired children and their relatives, and to advance the time of treatment. In this study, healthcare failure mode and effects analysis (HFMEA) was used to perform situation analysis, flow chart drawing, hazard analysis and decision tree analysis for the define method draft and effectiveness evaluation. The achievements of our study are (1) improved the neonatal hearing screening finish rate in hospital from 51% in 2015 to 92.7% in Feb 2017. (2) electronization of the medical personnel communication platform to improve the contact dilemma between medical and nursing units. The rate for the connection by electronics was achieved 100% during July to September in 2016. (3) Strengthen the ability for the screening of hearing impairment of nursing staff by on-job education. (4) fulfill the participation of newborn relatives and revise the unaccomplished hearing screening notice by interaction discussion. Improved the registration rate of hearing screening test in outpatient clinic from 65.6% in 2015 to 100% in Fed 2017. We hypothesized that using HFMEA can effectively analyzed and help solving complex medical procedures, and to increase the finish rate for the hearing screening in hospital. Our results provide a reference for the medical units nationally and benefit more newborn to establish a medical environment with the central dogma of patient safety.