加護中心護理品質監測模式工程再造

Reengineering Nursing Quality Monitoring System in ICU

品質監測的措施，不論為發掘問題、改善品質、亦或因應評鑑，均有其必要，本專案之目的，在發展一簡化之監測模式，並了解其在減少護理文書作業、降低人力成本、及提升護理照顧品質之成效。作者依兩加護單位原有之監測項目發展「加護中'\@-品質監測日報表」，將原由護理人員監測護理品質之措施，改為由護理長監測，經監測前後之品管文書作業量、護理品質得分、及護理人員素質測驗得分比較發現八1)兩單位每次監測表單共減少l6種、45張、633格;(@2)單位每月花費在監測的人力由91人次減至3人八3)單位每月花費在監測時間由96．2小時減為18．5小時:(4)不論經由測驗或護理人員自覺，護理照顧素質均有增加:(5)工程再造模式後，二單位之總品質均為上升。建議日後實施時可《1)每月隨機抽取10至l5夭，持續監測:(2)隨時取消長期維持穩定高品質的項目，以節省時間;'(3)逐月畫出每月的品質監測值曲線及閻值圖，以了解單位護理品質的現況趨勢;(4)單位了將常見之問題及缺失，加入監測表中列入監測;(5)將品質監測長期低下之項目，列入年度計畫，以專案方式個別探討。

A nursing quality monitoring system is necessary not only for detecting problems, improving nursing quality, but also for meeting the requirements of official evaluation of nursing quality.The purpose of this project was to develop a simplified monitoring system and to assess the degree of reduced paper work and work loading , as well as improved nursing quality. Through the implementation of the instrument in two ICU units and a shift of the monitor from nurses to the head nurse . The outcome revealed : 1.16 kinds, 38sheets, and 633 items of monitoring forms were reduced；2. The manpower involved was reduced from 9 1 persons to 2 persons; 3. The time used was reduced from 96.2 hours to 17.5 hours monthly；4.nursing quality was improved either by nurses subjective evaluation or by the evaluation of the monitoring head nurse；5. The nursing quality was improved in both ICU units after reengineering. We suggest that when this system is implemented on a whole basis: 1.continuous monitor for 10 to 15 days through random selection is necessary; 2.high score items can be replaced by low score items ; 3.draw the quality curve month by month to show the quality tendency; 4.include frequently occurring problems as a monitor item; 5. applying research project to solve the issue of low score items .