運用精實手法改善肺癌患者住院化療治療流程之專案

The Application of Lean Methodology to Improve Inpatient Chemotherapy of Lung Cancer Patients

周蜜淳(Mi-Chun Chou)；張淨淇(Jing-Ci Chang)；曾莉雯(Li-Wen Tseng)；許月麗(Yuen-Li Hsu)；呂佩珍(Pei-Chien Lu)

精實手法 ； 化學治療流程 ； 工作負荷 ； chemotherapy ； meticulous techniques ； workload

志為護理-慈濟護理雜誌

19卷4期（2020 / 08 / 01）

80 - 90

繁體中文

本專案目的為精簡肺癌患者住院等待化學治療作業流程。臨床常發生病患抱怨等待化療時間過久，護理人員疲於安撫病患、家屬及追蹤化療流程進度，故引發動機。經現況調查，開立醫囑至護理師執行化療給藥需等待127.7分鐘，原因:領用化療藥物作業流程繁瑣、化療與一般用藥分設不同藥局領取、聯繫領藥流程繁瑣。為達精實目的，擬定策略，刪除重覆4步驟，整合流程，增設電腦自動轉計價連線化療藥局通知配藥；跨領域協商統一領藥窗口並增設簡訊通知。結果化療流程下降至57.8分鐘，共減少69.9分鐘，達專案目的。運用精實手法除可改善肺癌患者等待化療時間，亦降低醫療團隊工作負荷，提高病患滿意度與工作效益，達患者、員工、院方三贏局面。

The purpose of this study was to devise methods to streamline the workflow for hospitalized patients with lung cancer undergoing chemotherapy. In clinical settings, patients often complain about the long waiting times to receive chemotherapy, and nursing staff is exhausted from appeasing the patients and their families and following up with them on the progress of the chemotherapy, leading to general demotivation. Upon investigating the situation, we found that the total waiting time from the doctor writing the prescription to the nurse performing the chemotherapy process is approximately 127.7 minutes. The reasons for the prolonged waiting times are as follows. First, the chemotherapy process is complicated. Second, the patients may need to visit different pharmacies to receive various chemotherapy and general drugs. Third, the drug delivery process is cumbersome. Therefore, to achieve precision, we formulated strategies, deleted repetitive steps, and used an integrated process. We applied a computerized automatic transfer process of pricing to the chemotherapy drug pharmacy, included a cross-domain consultation, and implemented a combined drug delivery window. Thus, a streamlined dispensing of medicines by the chemotherapy drug pharmacy could be achieved, after which SMS notifications were sent . This process reduced the waiting time to 57.8 minutes, with a total reduction of 69.9 minutes, thus achieving the purpose of the study. Applying lean methods to other areas of health care in addition to improving the waiting times for chemotherapy of patients with lung cancer can reduce the workload of the medical team; increase patient satisfaction and work efficiency; and result in the achievement of a win–win situation for patients, employees, and hospitals.

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