恢復室護理人員重症評估能力之改善專案

Improving nurses' assessment ability for critically ill patients in a post-anesthesia care unit

恢復室護理師最主要的功能是協助術後病人自麻醉中安全清醒以及預防手術和麻醉合併症的發生，因此照護處置及重症評估能力十分重要。在臨床照護經驗中，發現單位護理人員重症評估能力與執行紀錄缺乏一致性且不完整，以致病人照護時間長而延遲返室時間或是針對特殊異常狀況未及時發現造成再次手術時機延遲，影響手術預後情形。因此透過改善擬定四項解決辦法：舉辦急重症進階課程、修訂查核紀錄單、護理評估案例分析及護理紀錄查核。護理人員對術後麻醉恢復期病人照護認知正確率由71.9%提昇至85%，護理人員執行照護正確率及完整率各由83%、78%提昇至95%，已達專案目標。進而提升護理護理師重症評估能力及術後照護品質。

The main responsibilities of a nurse in post-anesthesia care unit (PACU) are to assist patients to regain consciousness safely and to prevent post-operation and anesthesia complications. Therefore, it is important that nurses are capable of critical care assessment. However, the critical care assessment and record taking abilities of PACU nurses are often inconsistent and incomplete. These deficiencies result in the delay of patients' return to the PACU or delay in subsequent surgery as a result of a lack of identification of a patient's special conditions, thereby affecting the surgical outcome. This study implemented four programs to resolve such issues: an advance critical care course, a revised checklist, case report analysis, and an audited nursing record. These programs improved post-operation nursing care from 71.9% to 85%. The accuracy and completeness ratings also increased from 83% and 78%, respectively, to 95%. The results of these programs improved the critical care assessment abilities and post-operative quality of care of PACU nurses and post-operative quality of care.