提升氣切醫病共享決策流程完整率之專案

A Project to Improve the Completeness of the Shared Decision Making Process for Tracheostomy

10.6320/FJM.202103_25(2).0006

林珍瑋(Chen-Wei Lin)；莊寶玉(Pao-Yu Chuang)；張寶綾(Bao-Lin Chang)；鄭之勛(Jih-Shuin Jerng)；古世基(Shih-Chi Ku)

氣切 ； 醫療共享決策 ； tracheotomy ； shared decision making (SDM)

台灣醫學

25卷2期（2021 / 03 / 25）

217 - 225

繁體中文

本專案旨在提升內科加護病房氣切SDM決策流程之完整率，因啟動氣切SDM後，發現流程完整率僅達76.7％，其主要原因為：醫護人員認知不足、不知道氣切SDM流程進行進度、繁忙遺漏、操作介面不友善、衛教資訊不足、未規範每項皆須完成、病人家屬認知不同、關鍵家屬沒來聽說明等。經透過SDM氣切決策流程海報宣傳、優化SDM資訊介面、氣切流程checklist查核、主護訪談指引、舉辦專科在職教育課程、操作流程線上教學影片等措施，氣切SDM決策流程完整率提升至94.1％，達到目標值；氣切病人平均氣管內管留置天數由21.4天縮短為18.6天，顯示本專案措施有效提升氣切SDM決策流程完整率與SDM成效。

This project aimed to improve the completeness of the tracheostomy shared decision-making (SDM) process in the medical intensive care unit. After this tracheostomy SDM was introduced, the process completion rate was only 76.7%, for which the main reasons included the staff's lack of cognition, unawareness of the actual progress, omissions due to busyness, unfriendly user interface, insufficient information of patient and family education, non-mandatory completion of the process steps, different perceptions among the family members, and the absence of key family members. By implementing the strategies including SDM poster promotion, optimizing SDM information interface, a checklist for tracheostomy, nurse's guidelines for the interview, specialist ongoing education courses, and online teaching videos, the completion rate of tracheostomy SDM increased to 94.1%, which has reached target value. The averaged endotracheal intubation duration was shortened from 21.4 to 18.6 days, showing the benefit of improving the completeness and effectiveness of the tracheostomy SDM process.