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題 名 | 運用六標準差改善加護病房病人安全之研究--以南部某區域醫院為例=The Study of Applying Six Sigma Methodology to Improve the Patient Safety in ICU--An Example of a Regional Hospital in South Taiwan |
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作 者 | 陳清軒; 潘豐泉; 徐婉貞; 陳森基; | 書刊名 | 大仁學報 |
卷 期 | 30 2007.03[民96.03] |
頁 次 | 頁63-81 |
分類號 | 419.38 |
關鍵詞 | 氣管內管; 非計劃性拔管; 六標準差; 護理改善專案; 持續品質改善; Endo-tube; Unplanned extubation; Six sigma; Nursing improving project; Continuous quality improvement; |
語 文 | 中文(Chinese) |
中文摘要 | 背景:近年來病患安全的議題受到世界各國的重視,尤其,在加護病房裡,維護病患呼吸道暢通的「氣管內管」留置,更是加護病房中呼吸障礙病患最常見的侵入處置。有許多因素導致病患非計劃性拔管,進而引發嚴重的合併症,甚而危及生命。氣管內管非計劃性拔除可說是一種醫療照護的不良事件,六標準差是探索不良事件或是出錯率(error rate)的一種管理哲學。本研究以臺灣南部某區域醫院為例,以加護病房使用「氣管內管」留置的病患為研判對象,針對氣管內管非計劃性拔除之事件,透過DMAIC之運作,達到降低非計劃性拔除率的機制,維護改善病人安全。 方法:本研究運用全面品質管理之理念及專案管理之實際演練,運用PDCA循環,整合六標準差與護理專案,透過個案醫院加護病房相關人員實際參與,落實對策執行,進而激發員工自主管理潛能及全院組織學習之機制。首先界定不良事件發生率的問題,接著衡量氣管內管非計劃性拔除的相關資料,建立專案規劃。然後使用多重工具衡量作業流程,分析原因,針對要因發展出預防錯誤的方法,實施對象後以新流程執行成果來評估,最後以組織學習模式歷經四個月的持續改善,評估新流程執行成果,編訂標準作業手冊作為流程標準化的範本。 |
英文摘要 | Background: In recent years, the issue of patient safety was paid attention to by the countries all over the world gradually. Especially, in ICU, applying the tracheal endo-tube to maintain the patient's airway is one of the most often used invasive treatment. There are many reasons to cause unplanned extubation (UE) among intubation patients, and then cause their serious complications, even threaten their life. Unplanned extubation is one of adverse events, and Six Sigma is a philosophy of management to explore these kinds of adverse event or error rate. This study takes one regional hospital of the south of Taiwan as an example, regard the patients who were applied tracheal intubation in ICU as the research objects. Focus on the unplanned extubation events, we achieve the mechanism of decreasing unplanned extubation rate by DMAIC, maintain and improve patient safety. Methods: This study applies the concept of the total quality control into the practical drill of special project management. WE integrate Six Sigma into Nursing improving project by CQI/TQM framework. Participate in actually through the relevant staffs of nursing department of the target hospital; build the concept of constructing higher quality, higher efficiency and lower cost with reducing defects. And then, promote the self-managing ability of the personnel and the mechanism of learning organization of the whole institution. At first we define the problem of the adverse event incidence. And then, measure the relative data of the unplanned extubation event, build the project plan. We use useful multiple tools to analyze performance process, and find the best process module. At analytic stage, we focus the causative reason to develop the method of protecting error. After implement the strategy, we evaluate the outcome by current process. Through continuous quality improvement of lasting four months by leaning organizational module, we assess the outcome, set up the Work manual, as the model of SOP. Outcome: Unplanned extubation rate decreased from 11.4% to 4.1% by CQI; Error rate improved from 2.71 sigma to 3.24 sigma. Conclusion: Because many healthcare organization pursue zero mistake, the opportunity to apply Six Sigma into health care has been already ripe. To the most organizations, it needs a lot of resources and may produce quite a lot of pressures to set up the special project of Six Sigma. But, in the course of health care, integrate the Six Sigma into the nursing improving project will be easily to be presented to the existing qualitative control outcome. During the course of this study, apply the Six Sigma to the existing nursing special project through the detailed data analysis, make the improving procedure become easy. |
本系統中英文摘要資訊取自各篇刊載內容。