癌症護理品質管制與監測

Quality Control and Monitoring of Cancer Nursing

自1982年以來我國十大死亡原因一直以癌症為首，2008年正式開始辦理「癌症診療品質認證」，然而根據國衛院於2013年度癌症診療品質認證醫院檢討會指出，關於護理品質管理的現況與常見問題為「未針對病房特性與病人需求訂定適切之監測主題，亦未建立適切指標與目標值」及「未針對監測結果進行原因分析，提出具體檢討改善措施及後續追蹤評值」，本文作者分享以JCAHO10步驟制定癌症護理監測計畫，依高服務量（High volume）、高風險（High risk）、高成本（High cost）、容易發生問題（Problem prone）四個面向找出重要照護面。然後檢視分析這些重要照護面是否曾經或較易發生問題？找出問題，依結構、過程、結果三層面來制定癌症護理品質指標及建立品質指標評核之閾值，然後收集資料與整理，並加以分析變異原因及找出改善方案。未來希望在癌症照護品質的監測增加以病人為中心的結果指標，並且可以呈現照護連續性，使癌症護理品質更加提升，病人的需求及生活品質能獲得滿足。

Since 1982, cancer was lead in the top ten causes of death in Taiwan. "Accreditation on program of cancer care quality " was implemented by the Bureau of Health Promotion in 2008. However, the National Health Research Institutes (NHRI) pointed out that some hospitals did not established appropriate indicators for ward characteristics and patients needs, nor set suitable threshold, and they did not analyzed and improved the causes of results. This author utilized the 10 steps to develop cancer care monitoring plan (JCAHO), including delineating scope of care and services, defining important aspects of care and services, identifying indicators, establishing thresholds for evaluation, collecting and organizing data, evaluating variation, and taking action. The patient-centered outcome indicators need to be increased in the future for purposes of monitoring the quality of cancer care, and to ensure that continuity of care can be rendered. The more cancer care quality is promoted, the more the patient's needs and quality of life can be met.