頁籤選單縮合
題 名 | 麻醉品質與病患安全的長庚經驗=The Experience of Continuous Quality Improvement and Patient Safety in Anesthesia in Chang Gung Memorial Hospital |
---|---|
作 者 | 呂炳榮; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 6:2 民93 |
頁 次 | 頁119-126 |
分類號 | 416.5 |
關鍵詞 | 麻醉持續品質改善計劃; 強迫性不良事件通報; 麻醉相關死亡率與不良預後; Anesthesia continuous quality improvement; Mandatory incident reporting system; Anesthetic-related mortality and adverse outcome; |
語 文 | 中文(Chinese) |
中文摘要 | 麻醉持續品質改善可減低不良預後的發生率。一個有效的品質改善計劃包括可靠的資料收集,客觀的分析,按實証來改變流程,以增進品質。本文目的是與大家分享林口長庚醫院麻醉部於2002及2003年施行麻醉持續品質改善計劃的經驗,証明它可有效減低不良預後的發生率。 我們的「持續品質改善計劃」豆透過醫護人員強迫填寫「異常事件通報單」,利用品管助理員核對所有麻醉記錄單,以確保麻醉不良預後編碼的準確性。此資料卡包括病人基本資料與手術前後併發症編碼(共248項),所有報告之不良預後均經麻醉部品管委員會的同儕審查,作人為或系統原因分析,包括兩天內死亡、重大併發症、輕微併發症、延長住院天數及「準傷害」等五種。此分析結果可作為流程再造或標準作業改變的依據。我們比較具2002年及2003年施行持續品質改善計劃後之不良預後,利用chi方統計法,P<0.05為具統計意義。我們彙總十萬餘例手術麻醉病患資料,資料填寫完整性達90%。兩年中無論在手術種類或病人分類上均無明確差異。麻醉相關死亡率2003年為十萬分之3.8,遠比2002年的12.9為低。重大併發症從四例淢至二例,「準傷害」從十九例大減至六例,均有顯著差異(P<0.05,表一),相反,在輕微併發症或延長住院等事件均無差異。在六十五件不良事件中,有四十七件屬人為原因,三十五件為系統原因。大部份人為原因是與呼吸道及心臟循環有關,多因知識不足或技術不良所致。因知識不足導致人為錯誤之發生率,從2003年的十三件遽減至三件。溝通不良,監督不週,作業標準限制為前三名常發生的系統錯誤的原因,兩年來三者均無明顯改善(九件比八件)。上述原因四成發生於麻醉甦醒期。 |
英文摘要 | A continuous quality improvement (CQI) ca improve adverse outcomes, which consists of data collection, factors analysis, and clinical process changes to enhance qualify. The purpose of this report is to share our experience in the improvement of perioperative outcomes after the implementation of the CQI in anesthesia (CQIA) from 2002 to 2003 in Chang Guang Memorial Hospital-Linkou. Our CQIA program consisted of mandatory incident reporting by anesthesia providers using a structured reporting form-database card. A CRNA reviewed all reports to confirm accurate and complete even coding. The database card included demographic data and perioperative event codes (248 items). All reported events underwent peer-reviewed analysis by the QA Committee to determine the human and system factors contributing to adverse outcomes, including death within 2 days, major and minor morbidities, prolonged hospitalization, and “near misses”. The results directed changes in clinical processes and standard protocols, and re-education of anesthesia providers. Chi squared test was used to compare adverse outcomes between the first and second year following CQIA implementation. P<0.05 was considered statistically significant. Two-year’s date of ten thousands’ patients were retrieved from the CQIA database for analysis with good compliance. The incidence of anesthetic-related mortality was 12.9 per 100,000 in the first year, and was significantly reduced by to 3.8 in 2003 *p<0.0001). major morbidity and near misses decreased significantly as well (P<0.05). In contrast, there no differences in minor morbidity or events causing prolonged hospitalization. Of the 65 individual events captured, more than half had human-and system-related factors. Most human factors were associated with airway and circulation-related event. The incidence of events associated with knowledge deficiencies decreased in 2003. communication errors, limitations of supervision and limitations of standards were the most commonly identified system factors in 2002, yet only communication persisted as a problem in 2003. most events occurred during the emergence of anesthesia. Our CQIA program appears to reduce anesthesia-related adverse outcomes with underreported minor morbidity and near misses. |
本系統中英文摘要資訊取自各篇刊載內容。