行動化手術前訪視系統之建置與成效評估

Implementation and Evaluation of the Mobile Preoperative Visiting Systems

國內醫療環境在全民健保政策實施下，病患平均住院日縮短，術前準備時間相當急迫，如何在有限時間內提供手術病患相關訊息與護理指導來達到手術全期照護品質之要求，則有賴於臨床照護資訊之有效整合與應用。本研究目的是以行動資通訊科技發展行動化術前訪視系統，建置術前訪視服務系統功能，包括病患術前評估與多媒體衛教，並應用行動化之資訊科技載具，來進行術前護理服務之提供，降低病患術前焦慮、提升照護品質。採用單一個案研究方法，依系統之建置與評估來進行發展，包括: 規劃階段、系統分析階段、系統開發與評值階段。在術前訪視系統之成效評估上，針對13 位專責術前訪視之護理人員進行系統滿意度調查，以及31 位使用術前訪視系統進行訪視個案之服務滿意度調查，結果顯示：在手術室護理人員對系統易用與有用性滿意度之解釋力為87.7% ，使用者之整體滿意度達69% ，病患整體滿意度達73% 。透過行動術前訪視系統發展，可讓護理人員在有限的時間內提供病患有效的訊息，增加病患相關資訊滿足之需求、減輕術前焦慮程度與減少併發症之發生，同時行動化服務，能即時與資料庫與知識庫之連結以輔助照護決策之應用，增加照護處理即時性，而系統之警示功能，可提高護理服務之完整性與降低錯誤率，並提升病人安全。

Under the implementation of national health insurance in domestic health environment, the average lengths of stay have been shortened, thus leading to a quite urgent time of preoperative preparation. In order to improve the quality of health care service in operation room, we implement the preoperative visiting, namely the key goal of perioperative nursing. However, the way of providing related surgery information about surgery patients and nursing education in a limited time to meet the efficiency of perioperative nursing depends on effective integration and application of information. So it will be a feasible solution of making the best use of the features of mobile health information systems which are developed from current situation. The purpose of this study is to develop “Mobile Preoperative Visiting System” by establishing the function of pre -operative visiting system which includes preoperative evaluation of patients, multimedia patient education and making use of the mobile information technology tools to provide preoperative nursing, so as to reduce patient anxiety, improve patient safety and improve health care quality. By using single case study, the implementation and evaluation of system are divided into three stages. The first stage is for planning. We should collect relevant literature on preoperative visiting, organize the necessary functions of this system and establish a feasible analysis of functional framework and technology application to the system. The second stage is for analysis. We should certify the spectrum of the system according to the needs of the users and the processes of preoperative visiting. The third stage is for development and evaluation, which includes the programming, testing and evaluation of the system. As for evaluation of preoperative visiting system, we carried on a satisfaction survey among 13 operation room nurses and 31 preoperative visiting users. The result indicates that: as for operation room nurses, the satisfactory rate towards usability and usefulness is 87.7%, among those who chose usefulness, over 84% agree with its better improvement in doctor-patient relationship and internal communication, over 76% agree with its promotion in amicability of working environment and 69% agree with its improvement in quality of patient safety nursing. The total satisfactory rate of operation room nurses is more than 69%. The total satisfactory rate of patients is more than 73%. Our study found that through the implement of mobile preoperative visiting system, it is possible for nurses to provide effective information of patients, to meet the demands of patients toward related information, to alleviate the anxiety before surgery, and to reduce complications. At the same time, mobile services can establish a real-time link between database and knowledge base to assist the application of nursing decisions, increase the real-time of medical management and alerting function of the system, improve the integrity of nursing and patient safety, and reduce medical error.