運用TRM方式處理呼吸照護病人疥瘡感染事件

Using team resource management to manage scabies in respiratory care patients

以病人為中心的醫療品質照護過程中，病人是否因感染而延遲出院，需要臨床各科部的團隊分工合作，無法僅單靠醫師或護理師的努力，往往需要良好的團隊合作以及不同專業間的合作，才能解決病人的問題，團隊資源管理TRM（Team Resource Management）便是透過系統性的訓練教材工具，促進成員間有良好的團隊合作，期達高水準之醫療照護品質，主要包含四個構面：領導（leadership）、狀況監測（situation monitoring）、相互支援（mutual supporting）、良好溝通（communication）。本研究運用TRM的方法處理呼吸照護病房疥瘡群聚感染事件，事件期間為2015年8月3日第一位發生個案至8月26日最後一位病人確診，此事件總計12人感染疥瘡，包含11位病人及1位護理師，經由利用TRM模式，醫療團隊含醫師、護理師、感管師、藥師、總務室等各科室專業人員組成小組討論並介入調查，經隔離及分區照護、環境清潔及全面預防性投藥等措施，有效控制後續感染。

In patient-centered medical quality care, whether the patient is delayed from discharge because of infection requires division of labor among the clinical departments and divisions. It cannot rely solely on the efforts of the physician or nurses, and often requires good teamwork and cooperation between different professions to solve the patient's problem. Team resource management (TRM) is a systematic training tool that promotes good teamwork among members to achieve a high level of medical care quality, which mainly includes the following four aspects: leadership, situation monitoring, mutual support, and communication. In this study, TRM was used to treat scabies cluster infection in respiratory care units. The event period was from the onset of the first case on August 3, 2015, to the last confirmed case on August 26, 2015. A total of 12 people contracted scabies infection, including 11 patients and a caregiver. By using the TRM model, the medical team, which was composed of physicians, nurses, sensory therapists, pharmacists, the general affairs officer, and other professionals, formed a group to discuss and participate in the investigation. The measures implemented, such as isolation and district care, environmental cleaning, and comprehensive preventive administration, were effective to control subsequent infections.