提昇神經內科病房院內急救完整性之專案

Project to Enhance the Integration of In-hospital Resuscitation in a Neurology Ward

背景：醫院內的急救過程複雜常需專業團隊合作，例行的急救訓練不代表能協同完成急救。當急救過程不完整相對危險性增加，患者死亡率與醫療糾紛率也將提升。目的：本研究透過執行專案提升急救完整度，藉由神經內科病房急救問題的剖析、改善醫護人員急救知識與團隊合作。
解決方案：分析本科別急救完整率僅71%，急救作業認知答對率為60.9%，經由訪談與要因分析，發現問題在「急救用物準備」、「急救設備使用」、「急救藥物給藥」、「急救團隊合作」這四大方面不完整。經問題分析與矩陣圖擬定改善方案包括制訂急救標準作業流程、職責分配辦法、模擬情境案例及演習方式，並運用增進團隊合作的圖卡提示( 職責分配對照圖、急救車藥物及醫材圖卡、電擊器及心電圖監視器簡易操作圖卡、禁N 藥物照片圖卡及提示語)，以落實方案的執行。
結果：護理人員急救知識分數在實施前測平均6.09 分( 滿分10 分)，後測平均分數9.23 分(t =10.46，p< .001)；急救過程完整率實施前平均11.06 分( 總分17 分)，實施後顯著提升至平均值16.06 分(t =13.04，p< .001)。
結論：本專案建立急救完整率提昇方案，以標準化流程與情境模擬、圖卡提示來強化團隊合作，多管並行下有效提升急救完整度與知識，進而增進醫護人員對於急救熟悉度。此結果將可供對於急救知識技能需要加強的單位或人員，作為常規急救訓練的補強作法。

Background: In-hospital resuscitation, an urgent and complicated procedure, is often carried out by a multidisciplinary team. Resuscitation accreditation as a routine does not guarantee that team members can complete such task cooperatively. Incomplete cardiopulmonary resuscitation will increase mortality and result in more medical disputes.
Purpose: The study described a project to enhance the completeness of in-hospital resuscitation by exploring problems of resuscitation process, improving rescue knowledge, and facilitating cooperative teamwork.
Solution: After analysis, the completion rate of performing resuscitation in our neurology ward was only 71%. Percentage of correct response on resuscitation knowledge was 60.9%. Group interviews and causes analysis were used to identify problems, which included four aspects: (1) preparation of rescue devices; (2) usage of medical equipment; (3) drugs delivery; and (4) team cooperation. A project was implemented to solve these problems step-by-step, including making a matrix map, creating a standardized procedure, establishing responsibilities and accountabilities, and performing simulation-based drill activities. In particular, a tip of reminder cards was designed to prompt teamwork cooperation. Content in these cards included responsibilities comparison chart, pictures of ambulance drugs and medical material, demonstration of defibrillators and ECG monitors, and drug pictures with reminders.
Result: aAfter implementing the project, average score of resuscitation knowledge increased from 6.09 out of 10 to 9.23. Average score of resuscitation completion has significantly increased from 11.06 out of 17 to 16.06 .
Conclusion: This project improved the performance of in-hospital resuscitation, Moreover, it effectively enhanced skills and knowledge among rescue team members. This results can serve as a reference for improving the quality of resuscitation.