降低急診護理人員執行急救處置缺失率

Reducing False Alarms and Absent Treatments by Nurses During Resuscitation in the Emergency Department

背景：以病人安全為中心是目前醫療管理的主流，尤其急救處置關係著病人生命安全，根據統計顯示2017年急診同仁反應的急救室急救處置缺失中，因新進人員評估錯誤而啟動急救小組造成家屬恐慌產生多件抱怨事件，引發專案小組進行改善的動機，調查顯示2018年6月急診急救處置缺失率為18.7％，分析缺失原因並確立問題為急救小組缺乏工作職責分配及新進人員實務訓練不足。目的：降低急診護理人員執行急救處置缺失率由原18.7％降低至0％。解決方案：修訂急救團隊角色工作分配、規劃使用「急救APP」、設計急救室急救小組位置圖、團隊擬真教育訓練及團隊分配作業宣導並建立定期稽核及持續追蹤制度。結果：經由專案實施改善後，急診護理人員執行急救處置缺失率由18.7％下降至0％。結論：急救流程與病人安全息息相關，團隊合作是其中最重要的因素，專案經由修訂「急救團隊工作職責分配」，舉辦「急救處置教育訓練」，其中包括「擬真實務訓練課程」，以提升急救人員團隊默契；藉由本專案改善策略，包括以急救作業職責海報及急救流程查核表來管理團隊運作，利用分工合作的團隊精神降低急救處置的缺失率，增進病人急救過程安全無虞、減少異常事件發生，提升團隊資源管理成效。

Background & Problems: Medical management protocols prioritize the safety of patients during emergency resuscitation situations. According to a medical center in Taiwan statistics gathered in 2017, the unnecessary activation of resuscitation teams by new nurses because of their improper assessment of patient conditions was a significant cause of anxiety in patient relatives and source of complaints directed at the medical center. In June 2018, 18.7% of the emergency resuscitation calls in the emergency department (ED) were false alarms or absent treatment incidents. After investigation, lack of clearly stated resuscitation team member responsibilities and insufficient practical training for new nurses were primary factors associated with the high rate of false alarm/ absent treatment incidents in the ED. Purpose: To decrease the rate of absent treatment by nurses during resuscitation from 18.7% to 0% in the ED. Resolution: The assignments of emergency team members were revised, a new ''Emergency app'' was introduced, the assignment schedule of the emergency resuscitation team was distributed, SIM realistic education training was held, stronger team work was promoted, and a standard assignment review schedule was established and regularly monitored. Result: After the introduction of the resolution measures, the false alarm/ absent treatment incidents in the ED caused by ED nurses dropped from 18.7% to 0%. Conclusion: Resuscitation workflow is closely related to patient safety, and teamwork among colleagues critical to successful resuscitation. The project revised resuscitation teamwork assignments and organized resuscitation education training, including simulation courses, to enhance the understanding of team members. The strategy outlined in this paper may be used to raise awareness using posters and resuscitation record checklists to track and manage the team's progress. This project was designed to enhance teamwork to decrease the rate of absent treatment and to provide safe and quality resuscitation care in order to improve resource management by the team to increase productivity.