從國際醫院評鑑規範及相關法規探討如何提昇病歷檔區設施安全性

Through JCIA Standards and Related Regulations to Study how to Improve the Safety of Medical Record Room Facilities

鑑於病歷對病人照護及醫療資訊保存的重要，本文除依國際醫院評鑑第11章「設施管理與安全」中，對於公用設施維護的要求外，更由設施建置階段即引進計畫、執行、檢查、反應（PDCA）及工程三級品管的作法，研擬一個含括中下游的全面性設施管理計畫，以期消除系統介面問題，建立一個環境安全及設施完備的病歷檔區。本管理計畫中首先盤點應有設施及法規要求，瞭解一個完備檔區應有那些設施及法規要求，其次就該些設施進行缺失分析，並據以擬定建置改善計畫、維護與巡檢計畫、品管計畫及教育訓練計畫、緊急應變計畫。本設施管理計畫發展架構極為完整，不論對於醫療機構的新建工程或舊空間的整修與維護，均可參考使用，惟各醫療機構仍須依其特性進行反覆的PDCA，方可建構一個最適合的設施管理計畫。

In view of the vital importance of medical records to good patient care and sound preservation of medical information, other than emphasizing the compliance with public facility maintenance requirements specified in Chapter 11 of JCIA (Joint Commission International Accreditation), Facility Management and Safety, this article also introduces a Plan-Do-Check-Act (PDCA) cycle and a Three-Level Quality Control scheme in a step-by-step development process for a thorough, dressing all the mid- and downstream concerns, facility management plan, in the hope to eliminate systemic interface problems and establish a well-functional medical record room with safe environment. In this plan, we started the process by first looking into all the facility elements called for and existing regulation requirements to understand what an ideal, complete medical record room ought to be, then it was followed stepwise by the development of some facility failure mode analyses, which in turn led to the establishment of some improvement plans, preventive maintenance plans, quality control plans, employee training plans, and contingency plans. The developing framework of this facility management plan is extremely integrated, and can be referred to and applied in a medical organization's new construction project and any renovation or regular maintenance project thereafter. The only caution to bear in mind is that after the adoption of this plan a medical institution still needs to proceed with the PDCA cycle repeatedly before achieving its own best facility management plan.