加護中心護理品質監測模式工程再造

Reengineering Nursing Quality Monitoring System in ICU

10.6142/VGHN.20.3.282

王曼溪(Man-His Wang)；李碧華(Bea-Hua Lee)；余幸澄(Hsing-Cheng Yu)

護理品質 ； 監測系統 ； 工程再造 ； nursing quality ； monitoring system ； reengineering

榮總護理

20卷3期（2003 / 09 / 01）

282 - 293

繁體中文

品質監測的措施，不論爲發掘問題、改善品質、亦或因應評鐘，均有其必要，本專案之目的，在發展一簡化之監測模式，並了解其在減少護理文書作業、降低人力成本、及提升護理照顧品質之成效。作者依兩加護單位原有之監測項目發展「加護中心品質監測日報表」，將原由護理人員監測護理品質之措施，改爲由護理長監測，經監測前後之品管文書作業量、護理品質得分、及護理人員素質測驗得分比較發現：(l)兩單位每次監測表單共減少l6種、45張、633格；(2)單位每月花費在監測的人力由9l人次減至3人；(3)單位每月花費在監測時間由96.2小時減爲l8.5小時；(4)不論經由測驗或護理人員自覺，護理照顧素質均有增加；(5)主程再造模式後，二單位之總品質均爲上升。建議日後實施時可：(l)每月隨機抽取l0至l5天，持續監測；(2)隨時取消長期維持穩定高品質的項目，以節省時間；(3)逐月畫出每月的品質監測值曲線及閾值圖，以了解單位護理品質的現況趨勢；(4)單位可將常見之問題及缺失，加入監測表中列入監測；(5)將品質監測長期低下之項目，列入年度計畫，以專案方式個別探討。

A nursing quality monitoring system is necessary not only for detecting problems, improving nursing quality, but also for meeting the requirements of official evaluation of nursing quality. The purpose of this project was to develop a simplified monitoring system and to assess the degree of reduced paper work and work loading, as well as improved nursing quality. Through the implementation of the instrument in two ICU units and a shift of the monitor from nurses to the head nurse. The outcome revealed: 1.16 kinds, 38sheets, and 633 items of monitoring forms were reduced; 2. The manpower involved was reduced from 91 persons to 2 persons; 3. The time used was reduced from 96.2 hours to l7.5 hours monthly; 4 The nursing quality was improved either by the nurses subjective evaluation or by the evaluation of the monitoring head nurse; 5. The nursing quality was improved in both ICU units after reengineering. We suggest that when this system is implemented on a whole basis: 1.continuously monitoring for 10 to 15 days through random selection; 2.replacing high score items by low score items; 3.drawing the quality curve month by month to show the quality trend; 4.including frequently occurring problems as monitor items; 5.applying research projects to solve the issue of low score items.