提升加護病房照護團隊對危急型先天性心臟病新生兒立即處理能力

本單位於2014年開始收治產房直入危急型心臟病新生兒，且個案數逐年上升，面對新業務的挑戰若立即處理能力不足時，將危及新生兒的存活及預後，甚至衝擊照護團隊工作士氣。經直接觀察照護10位新生兒顯示：照護團隊執行立即處理能力完成率僅77.6%。根據人員認知及情意行為調查，確立本專案主要問題為：（一）現行無「產房直入危急型心臟病新生兒立即處理作業標準」；（二）醫護人員缺乏對產房直入危急型心臟病新生兒立即處理的教育訓練；（三）無統一的備物標準。改善策略包含：制定「產房直入危急型心臟病新生兒處理流程」與舉辦教育訓練課程及建立新生兒立即處理箱與文件包。團隊立即處理能力完成率由77.6%提升至99.4%，進而提升醫療照護品質。 Since 2014, the infant intensive care unit(IICU) has been responsible for both treatment and care of newborn infants with critical heart disease. Given the importance of both quality and timeliness in the care of these high-risk patients, it is critical that the IICU team has a high level of competency while dealing with these fragile infants not only to avoid long-term health complications for these children, but also for the morale of the team responsible for providing this important care. Based on observations of the care of 10 critical infants by the IICU team, the completed percentage of all tasks pertaining to ‘immediate care' was found to be 77.6%. According to a survey of the sample, three main reasons were found to explain the incomplete tasks: (1) a lack of standard operating protocols governing immediate care activities; (2) insufficient clinical experience by staff responsible for administering care; and (3) lack of team skills, causing insufficient communication and co-ordination amongst team members. To address these concerns, a combination of process training and team simulation exercises was applied. As a result, critical care completion rates have subsequently improved from 77.6% to 99.4%.