運用目視化管理提升護理人員執行臨床路徑之完整率

Application of Visual Management to Enhance the Completion Rate of Clinical Pathways

臨床路徑可作為護理人員照顧病人的護理計畫依據。若護理人員未能依臨床路徑內容執行照護及衛教時，易影響病人自我照顧能力，降低照護品質。2017年4月至6月護理人員執行臨床路徑完整率僅有31.2％。經逐步問卷調查確認要因為：缺乏提醒工具；對臨床路徑內容認知不足；不熟悉臨床路徑內容；未明確規範執行流程。針對上述缺失制定改善對策：運用目視化管理方式建立有效提醒機制、舉辦教育課程、舉辦臨床路徑病人討論會及落實臨床路徑標準作業流程。透過對策執行後，臨床路徑完整率由31.2％提升至82.7％。14天再入院率也因此由13.5％下降至2.7％。建議透過目視化管理改善工作現場，可落實執行臨床路徑衛教內容之完整率，提升病人自我照顧能力，進而降低再入院率。

A clinical pathway can be used as a basis for nursing care plans. If a nurse is unable to perform care and education according to this pathway, the patient's self-care ability can be easily affected, resulting in reduced quality of care. A study conducted from April to June 2017 revealed that the clinical pathway completion rate was low, only approximately 31.2%. After investigation, the lack of a reminding tool, deficiency of nursing recognition of the clinical pathway, and unfamiliarity with its content were observed, and no standard procedure had been established. Resolution methods included using visual management, conducting education classes for nurses, conducting seminars on the clinical pathway, and implementing standard workflow of the clinical pathway. The results indicated that the completeness of the clinical pathways performed by nurses increased from 31.2% to 82.7%. Moreover, patient readmission within 2 weeks decreased from 13.5% to 2.7%. Our implementation of the visual management program not only assisted in clinical pathway completion but also improved patient self-care ability and reduced the readmission rate.