提升急診病人進住加護病房轉送與交班完整性之改善專案

Project for Improving the Integrity of Transfer and Handover of Emergency Patients Entering the ICU

10.29494/LN.202009_21(3).0010

鄒心茹(Hsin-Ju Chou)；徐幸琪(Hsing-Chi Hsu)；曾凱郁(Kai-Yu Tseng)

急診病人 ； 轉送 ； 交班 ； Emergency patients ； Transfer ； Hand-over

領導護理

21卷3期（2020 / 09 / 01）

124 - 140

繁體中文

病人安全轉送後以交班延續護理責任，經由有效溝通與訊息完整傳遞落實護理的持續性，有助於護理人員正確掌握病人照護重點，並節省接班者重新評估的時間。調查發現急診病人進住加護病房轉送交班之完整性僅達76.0%，加護病房護理師對急診病人轉送交班滿意度為2.88分，經現況分析問題為：缺乏重症病人轉送與交班標準、缺乏結構化交班工具、缺乏重症病人轉送與交班查核機制、未提供重症病人轉送交班安全相關在職教育。專案小組根據問題制訂結構化「急診重症病人轉送安全評估表」、運用ISBAR原則修訂結構化「急診病人住院交班單」、護理記錄以轉出摘要呈現病人概況、建立急診重症病人轉送與交班標準、安排重症病人轉送交班安全在職教育，並建立重症病人轉送與交班查核機制，作為解決方案。專案實施後，急診病人進住加護病房轉送交班之完整性由76.0%提升至92.4%，加護病房護理師對急診病人轉送交班滿意度由2.88分提升至4.32分。本專案實施成效除改善急診病人進住加護病房轉送與交班的完整性，與加護病房護理師對急診病人轉送及交班之滿意度外，亦提升急診與加護病房照護人員間之有效溝通，落實病人醫療照護之持續，達到病人安全目標。

After the patient is safely transferred, the continuation of care through the effective communication and complete transmission of information will helps the nursing staff to correctly grasp the patients' care focus and saves the time for the successor to reevaluate. The survey found that the completeness of transferring emergency patients to the ICU was only 76.0%. The satisfaction of the nurses in the ICU on the transfer of the emergency patients was 2.88 points. The analysis identified issues include: lack of standard operating procedures of transfer and handover of emergency patient; lack of structured handover tools; lack of check-up mechanism for transfer and handover of critically ill patients; and no on-the-job training of safety transfer and handover. The project team formulated a structured 〞emergency critical patient transfer safety assessment form〞 based on the issue, revised the structured 〞emergency patient inpatient transfer form〞 using the ISBAR principle; nursing records with a summary of the transfer to present the patient's overview, also established emergency patient transfer and handover standards. Arrange for the transfer of critically ill patients to the safe on-the-job education, and establish a mechanism for the verification and transfer of critically ill patients as a solution. After the implementation of the project, the completeness of the transfer of emergency patients entering the ICU had improvement from 76.0% to 92.4%, and the transfer and handover satisfaction of the nurses in the ICU with the transfer of emergency patients went up from 2.88 points to 4.32 points. The effectiveness of the implementation of this project has not only improved the integrity of the transfer and handover of emergency patients in the ICU; and the satisfaction of the nurses in the ICU with regard to the transfer and handover of the emergency patients, it also improved the effective communication between the emergency and ICU caregivers and implementation to the patients for the consistency in medical care service that is aiming to achieve the patient safety.

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