運用精實管理改善加護病房COVID-19病人入院護理流程

Using Lean Management to Improve the Nursing Admission Process for COVID-19 Patients in the Intensive Care Unit

10.6224/JN.202408_71(4).10

曹心怡(Hsin-Yi TSAO)；莊寶玉(Pao-Yu CHUANG)；龔淑櫻(Shu-Ing GONE)；王佑平(You-Ping WANG)

加護病房 ； COVID-19 ； 入院護理流程 ； 精實管理 ； intensive care unit ； COVID-19 ； nursing admission process ； lean management

護理雜誌

71卷4期（2024 / 08 / 01）

81 - 88

繁體中文;英文

背景：安全、有效率的作業流程能減輕工作負擔、提升照護品質及工作滿意度。現況調查發現單位COVID-19病人入院護理流程冗長，導因為等待醫師進入病室與外場人員協助、備物凌亂導致重複分類、醫材放置不集中導致來回走動、記錄受干擾中斷、非專業性說明及同意書簽署耗時。目的：運用精實管理改善COVID-19病人入院護理流程時間。解決方案：藉由修訂入院護理流程及工作職責、制定遠距簽署同意書、智能衛教小幫手、修訂備物流程、規劃入院護理工作車等策略簡化流程。結果：病室內作業流程時間由105分鐘縮短為73分鐘，降幅達30.5%；入院流程總護理時數由504分鐘縮短為332分鐘，降幅達34.1%，護理工作滿意度由55.4分提升至82.7分。結論：本專案藉由精實管理檢視COVID-19病人入院護理流程，繪製價值流程圖，發掘流程中的低價值活動，藉由專案措施介入及制定標準化流程，能有效改善流程耗時，減少人力成本，提升工作滿意度。

Background & Problems: Safe and efficient operational workflows in nursing care can alleviate workloads, enhance quality of care, and improve job satisfaction. A recent survey indicates that the admission process for patients with COVID-19 in nursing care is excessively lengthy due primarily to the waiting time for physicians to enter the ward, external support, and frequent reorganization of medical materials. Inadequate organization measures have resulted in requisite materials not being centralized, leading to increased travel times, interruptions in nursing records maintenance, unprofessional explanations, and time-consuming consent form signing processes. Purpose: In this project, lean management was implemented to reduce the time spent on the nursing admission process for patients with COVID-19. Resolutions: The nursing admission process and job responsibilities were revised. Furthermore, new policies were implemented, including introducing remote consent form signing, using intelligent digital health education assistants, revising related inventory processes, and planning admission nursing carts to streamline the admission process. Results: The average processing time in the isolation room was reduced by 30.5% from 105 minutes to 73 minutes; the average time spent by nurses on the admission process was reduced by 34.1% from 504 minutes to 332 minutes; and nursing satisfaction levels rose from 55.4% to 82.7%. Conclusions: In this project, lean management was used to investigate the nursing admission process for patients with COVID-19 and a value stream map was compiled to identify low-value activities within the process. Through the implementation and standardization of project measures, processing time was effectively reduced, manual labor was minimized, and job satisfaction improved.

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