運用團隊資源管理模式提升兒童加護病房急救作業完整性

Use of Team Resource Management (TRM) Model to Improve the Integrity of First Aid Operation in Pediatric Intensive Care Unit

現況發現兒童加護病房執行急救時，有分工不當、過程忙亂，導致急救作業完整性不佳，引發小組成立動機。調查發現單位執行急救完整性63.8%、認知71.7%。分析問題：（一）急救流程不完善（無清楚劃分職責、明定ISBAR交班及會後檢討）（二）急救認知不足（無舉辦高擬真訓練、醫師對兒童劑量不熟）（三）急救車物料不符合需求及無急救設備擺放標準。專案目的為提升兒童加護病房急救作業完整性至95.4%。經專案小組修訂急救作業流程、職責小卡、急救手冊提醒標籤、急救BoBo車、病室設備擺放標準、教育訓練，使急救完整性上升至96.1%，認知上升至97.6%，達專案目的。建議臨床可定時舉辦急救高擬真訓練及導入TRM模式，讓人員對於急救時的分工能更加完善，以提升急救作業品質。

The current situation reveals shortcomings in the pediatric intensive care unit's resuscitation procedures, marked by an inadequate division of responsibilities and a chaotic process, resulting in compromised resuscitation operations. This observation has motivated the initiation of a project to establish a dedicated team. An analysis of the current situation indicates that resuscitation operations exhibit 63.8% integrity and 71.7% knowledge. Identified problems include: (1) incomplete resuscitation standard operating procedures, lacking clear division of responsibilities, ISBAR shift clarity, and postmeeting review; (2) insufficient knowledge about resuscitation due to a lack of regular high-fidelity training and doctors being unfamiliar with pediatric dosages; and (3) inadequacies in ambulance materials meeting requirements, coupled with the absence of a standardized resuscitation equipment placement protocol. The project's objective is to enhance resuscitation integrity in the pediatric intensive care unit to 95.4%. Through the implementation of resuscitation standard operating procedures, responsibility cards, resuscitation reference manual reminder labels, resuscitation BoBo cars, standards for ward equipment placement, and educational training initiatives, the resuscitation integrity improved to 96.1%, while knowledge increased to 97.6%, successfully achieving the project's goals. It is recommended that the clinic organizes regular high-fidelity training sessions and adopts the TRM mode to further refine the division of responsibilities in resuscitation, ultimately improving the overall quality of resuscitation efforts.