提升內科病房護理交班之成效

Promotion of Efficiency of Nursing Works during Nursing Shift Changing in Medical Wards

以病人為中心的照護是醫療安全管理重要目標，無效率交班因資料不齊而危害病人安全。統計南部某醫學中心護理部2011 年病人安全監控交班時段發生管路滑脫率0.09%(17件)、跌倒率0.08%(8 件)，調查護理師交班平均28.7 分鐘。分析問題為交班時間太長所致，針對導因：護理師交班缺乏一致性、交班過程易中斷、無制訂交班標準程序、稽核制度及電腦交班畫面無一致性。解決之道為錄製預防交班被中斷的教學影帶、制訂交班規範、稽核辦法及設立電子病歷簡潔化、改變交班模式-- 床邊交班。專案改善後交班平均時間10-20 分鐘，管路滑脫率降至0.04%(4件)、跌倒率0.02%(2件)，證實本專案不僅提升交班成效，進而增進病人安全照護品質。

Care centered on patients is a critical indicator for management of medical safety. Professional nurses perform continuous care with shift information, while inefficient shift change endangers safety of patients in case of insufficient information. An investigation in 2011 had revealed that the tube slippage rate was 0.09% and fall rate was 0.08% during shift change period and the average time spent on shift change was 28.7 minutes. After analyzing the information, the results indicated that the reasons for delay in hand-over included inconsistent hand-over, interruption during hand-over, , lack of standardized procedure and an audit system, and inconsistent computer system for hand-over. Solutions included providing educational video for preventing hand-over from being interrupted, establishing standard hand-over procedures and auditing protocols, , developing a simplified e-progress note system, and utilizing bedside hand-over method. After implementing the project, the average time spent on shift change ranged between 10 and 20 minutes, , the tube slippage rate dropped to 0.04%, and the fall rate dropped to 0.02%. The project enhanced the efficiency of shift change and improved the quality of care and patient safety.