提升高壓氧治療作業完整性

Improving the Integrity of Hyperbaric Oxygen Therapy Operation

高壓氧治療作業若執行不完整可能影響治療過程之安全，而高壓氧治療過程及護理記錄不完整將導致健保審核時退件，需重新申報而增加來回重覆作業次數及時間；傳統的人工作業流程可能造成作業遺漏及增加工作負荷，透過資訊化的導入可提升更有效益的作業模式。本單位發現2018年記錄不完整件數較2017年高出94件，經健保局審查後需補述及重新審核；進艙前未確實檢核而延遲治療及病人耳壓無法平衡而延長治療時間，作業耗時亦導致護理師延遲下班，引發本專案動機，期望改善作業完整性及提升病人安全。分析問題為醫囑開立不完整、護理指導不完整、輸入治療排程不完整、進艙前檢核不完整、出艙評估不完整及治療記錄不完整。解決方案包含建構高壓氧醫囑資訊化、製作多媒體衛教影片、高壓氧排程系統資訊再造、製作進艙前檢核表及出艙評估表、建構高壓氧治療記錄資訊化及重整高壓氧治療作業流程。改善後高壓氧治療作業完整性由89.5%提升至100%，作業時間大幅減少，護理師逾時下班率降至0%，實施成效良好平行展開其他院區。治療作業資訊化過程中曾出現伺服器異常而造成系統當機，因此必須恢復人工紙本作業，此為專案執行後延伸之另一問題，需待院方全面進行系統升級，才能使作業系統能更加穩定。

Incomplete hyperbaric oxygen therapy (HBOT) records can impact the safety of the therapy and lead to rejection for national health insurance reimbursement, resulting in a time-consuming and repetitive reimbursement process. The traditional manual workflow is prone to errors and can increase the risk of work omissions and higher workloads. An informatics system can significantly enhance the efficiency of the workflow. In our unit, there were 94 more cases of incomplete HBOT records in 2018 compared to 2017, which required revision and reexamination by the Bureau of National Health Insurance. Two key issues prompted the initiation of this project: 1. Inexact check-out procedures: Inaccurate checkout procedures before entering the HBOT chamber, coupled with difficulties in maintaining patients' ear pressure balance, resulted in therapy delays. 2. Time-consuming operations: cumbersome and timeconsuming operational processes led to delays in work hours. The causes included incompleteness in medical orders, inadequacies in nursing guidance, errors in therapy schedule entry, deficiencies in in-chamber checks, incomplete out-chamber evaluations, and inaccuracies in therapy records. The improvement included: construction of a computerized HBOT medical order and scheduling system, development of multimedia health education videos, introduction of in-chamber checklists and outchamber Evaluation forms, and reform of the computerized HBOT record and workflow. After implementing, HBOT operation integrity increased from 89.5% to 100% and operation time substantial reduced. Subsequently, this plan was adopted in other affiliated hospitals. During the implementation, an unexpected issue arose, where server abnormalities caused the informatics system to shut down, necessitating manual paper-based operations during downtime. This underscored the need for a comprehensive hospital-wide informatics system upgrade to ensure system stability.