提升供應室對手術租賃器械執行效率之改善專案

Improving the Efficiency of Surgical Instrument Rental in Central Supply Rooms

目的
過去供應室未承接手術室器械業務，自從手術租賃器械開始回歸供應室後經常發生：清洗器械時未拆解、器械盒內擺放凌亂、配盤時器械組裝困難、送回的器械有短少等情形發生；而且租賃器械經常於各醫院間交替使用，一旦未完成清潔消毒極可能成為病原微生物之間傳播，藉此流程的改善可提升手術租賃器械執行效率，為病人手術安全及醫療品質把關。
方法
現況調查發現，人員對於租賃器械不熟悉、未確實盤點造成器械短少問題、未規範器械盒放置標準及缺乏手術租賃器械管理流程，對於手術租賃器械執行效率為62.5％。為此分別於人員、設備及政策面設計出解決方案，包含：加強人員教育訓練、器械盒標準化、建置供應室手術租賃器械管理流程等措施。
結果
手術租賃器械執行效率從62.5％提升至97.2％，附帶效益其處理流程所花費時間由55.3分鐘下降至43.9分鐘，不僅解決了臨床問題也提升了管理成效。
結論
因環境改變醫療體系逐漸朝向無菌器械清潔、消毒、滅菌均由特定單位負責執行，除了制定作業流程外，定期監測、查核才能確保無菌物品的品質，以提升病人手術安全及醫療品質。

Purposes
In the past, central supply rooms did not rent surgical instruments. Since the establishment of rental operations to central supply rooms, several problems frequently occurred, such as instruments not being disassembled during cleaning, haphazardly arranged boxed instruments, difficulty assembling surgical instruments, and lost rentals on return. Moreover, rented instruments were often used alternately between hospitals and got contaminated; if not cleaned and disinfected adequately, they seemingly disseminated pathogenic microorganisms in these places. Changing operating procedures can improve the efficiency of surgical instrument rental, thereby helping to ensure the safety of surgeries and the quality of medical care for patients.
Methods
A survey conducted revealed a surgical instrument rental efficiency rate of 62.5%. Problematic issues included unfamiliarity with the instrument rental, lack of inventory leading to a shortage of instruments, lack of standardized regulations on the placement of boxed instruments, and lack of management processes for surgical instrument rental. Solutions were designed accordingly regarding personnel and equipment management, besides policies, including strengthening personnel training, standardizing instrument boxes, and establishing a management procedure for renting surgical instruments in the supply room.
Results
Upon implementation of these measures, the efficiency of surgical instrument rental increased from 62.5% to 97.2%. Moreover, the processing time was reduced from 55.3 to 43.9 minutes. The results solved clinical issues and improved management efficiency.
Conclusions
Changes in the medical environment induced gradual transformation in the medical system that warranted specific institutions to perform instrument cleaning, disinfection, and sterilization. Besides establishing standardized operating procedures, regular monitoring and inspections should be performed to ensure the quality of sterile items and medical standards to improve patient safety.