醫療品質雜誌最新文献

{"title":"提升居家老年人用藥整合率","authors":"何京撰 何京撰, 張豐媚 Ching-Chuan He, 楊靜如 Feng-Mei Chang, 陳怡君 Ching-Ju Yang","doi":"10.53106/199457952023051703007","DOIUrl":"https://doi.org/10.53106/199457952023051703007","url":null,"abstract":"\u0000 目的：「提升用藥整合」列為醫療品質及病人安全工作目標之一，隨著進入高齡社會併多重慢性病，顯見整合用藥之重要性。材料與方法：實施對象為居家老年人，本專案期間為2020年1月1日至2021年3月31日。統計2020年1月至3月居家老年人用藥整合率僅11.8%，分析用藥整合不良原因：缺乏用藥整合指導工具、沒有窗口諮詢、缺乏居家用藥整合流程、住院期間無法得知用藥整合訊息，予介入策略：一、制定用藥整合宣導影片及衛教單張；二、提供地段專責護理師聯繫名片；三、建置用藥整合作業標準；四、制定用藥整合查檢表；五、辦理單位出院準備專責教育訓練。結果：經專案實施後，居家老年人用藥整合率由11.8%提升至84.6%，目標達成率151%。結論：專案持續執行策略6個月，效果維持期仍有82.3%。\u0000 Purpose: Improving medication reconciliation is listed as one of the goals for quality of care and patient safety, particularly in an aging society with multiple chronic diseases. Materials and Methods: This study enrolled older adults in home care, and the study period was January 1, 2020, to March 31, 2021. From January 1, 2020, to March 31, 2020, the medication reconciliation rate for older adults in home care was only 11.8%. After the collection of up-to-date data, Pareto charts and cause-and-effect diagrams were used to identify the following causes underlying the low reconciliation rate: lack of medication reconciliation guidance tools, lack of primary contact information, lack of implementation of home medication reconciliation procedures, and a lack of medication reconciliation information available during hospitalization. The following intervention strategies were implemented: (1) development of promotional videos on medication reconciliation and health education leaflets, (2) provision of contact cards for designated nurses in the region, (3) establishment of working standards for medication reconciliation, and (4) formulation of edication reconciliation lists. Results: By the end of the study period, the medication reconciliation rate for older adults in home care had increased from 11.8% to 84.6%. The goal achievement rate was 151%. Conclusion: At the 6-month follow-up after the end of the study, the reconciliation rate remained at 82.3%.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128340860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"遠距醫療的風險與挑戰—簡介美國健康照護促進協會（IHI）「遠距醫療：確保安全、公平、以人為本的虛擬照護」白皮書","authors":"艾鈞偉 艾鈞偉, 楊家睿 Jun-Wei Ai, 吳堯達 Jia-Rui Yang, 許惠淑 Yao-Ta Wu, 王拔群 Hui-Shu Hsu","doi":"10.53106/199457952023051703001","DOIUrl":"https://doi.org/10.53106/199457952023051703001","url":null,"abstract":"\u0000 遠距醫療在各國有不同的發展進程，國際間也不斷探討遠距醫療難以發展或被廣泛使用的原因，其不外乎受科技基礎建設、社會進步程度、醫療環境、政策、保險制度的差異、民眾需求與就醫習慣及文化背景等因素之影響。2021年，美國健康照護促進協會（Institute for Healthcare Improvement, IHI）發布一份有關遠距醫療發展建議的白皮書，提供一個高品質的虛擬照護模式，並擬定一個確保安全、公平、以人為本的遠距醫療架構，其中包含了六個要素：「可近性」、「隱私」、「診斷準確性」、「溝通」、「安全感」及「人因與系統設計」，並提出相關執行建議。遠距醫療已成為各國後疫情時代的新醫療常態，遠距醫療發展過程中，醫療照護體系和醫療服務提供者除維持照護品質外，更應重視虛擬照護獨特且潛在地意外和風險。期待透過本文的分享，可以讓醫療照護體系及單位重視並建立安全、公平、以人為本的遠距醫療制度。\u0000 Telemedicine has been developed in different processes in each country. International academic circles have discussed the causes of difficulty in developing or spreading the use of telemedicine, which is affected by factors such as technological infrastructure, social progress, medical environment, policies, differences in insurance systems, public needs, medical habits, and cultural backgrounds. In 2021, the Institute for Healthcare Improvement from the United States of America published a white book on telemedicine development. The white book advocates for providing a high-quality virtual care model and developing a safe, equitable, and person-centered telemedicine framework. The framework consists of 6 elements: access, privacy, diagnostic accuracy, communication, psychological and emotional safety, and human factors and system design. The white book also provides practical suggestions on telemedicine. Telemedicine has become a new medical normal for various countries in the post-COVID era. In developing telemedicine, healthcare systems and providers must not only maintain the quality of care, but also pay attention to the unique and potential accidents and risks involved in virtual care. The results of this study provide a key reference to health care systems and personnel in establishing a safe, equitable, and person-centered telemedicine system.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122892507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"台灣主要醫事人員的性別差異近況及其趨勢","authors":"許智恩 許智恩, 李瀚恩 Chi-En Hsu, 韓德彥 Hon-Ian Lei","doi":"10.53106/199457952023051703012","DOIUrl":"https://doi.org/10.53106/199457952023051703012","url":null,"abstract":"\u0000 本研究旨在探討臺臺灣醫事人員的性別、年齡結構近況，並探討其未來變化趨勢。資料來源為2014年至2021年衛生福利部統計處公布之醫事人員登記資料。結果發現16類師級人員中，護理師女性占比最高(96.17%)，其次為營養師(90.57%)，最低的三類醫事人員則為中醫師(32.77%)、牙醫師(30.09%)、西醫師(21.16%)。上述五類醫事人員的男女比例在這8年都有逐漸平衡的趨勢，惟推估護理師約需184.5年才能達到男女人數相當，醫師則約需30~40年。此年數可作為職系性別平等的一項參考指標，提醒家庭、學校、社會加強男女醫事人員投入醫療工作的自由平等。\u0000  This study explored the gender and age distributions of health care personnel in Taiwan at present and in the future. Data from the Ministry of Health and Welfare for the 2014–2021 period were retrieved from a database containing the registration information of health care personnel. This study discovered that among 16 types of health care personnel, nurses and nutritionists had the highest and second highest proportions of women, respectively (nurses, 96.17%; nutritionists, 90.57%), whereas traditional Chinese medicine (TCM) physicians, dentists, and physicians had the lowest, second lowest, and third lowest proportions of women, respectively (TCM physicians, 32.77%; dentists, 30.09%; physicians, 21.16%). From 2014 to 2021, the gender distribution for these five types of health care personnel gradually became more balanced. However, the time required to achieve gender parity (indicated by the male-to-female ratio) was estimated to be approximately 184.5 years for nurses and approximately 30–40 years for physicians. These numbers of year can serve as references on the state of gender equality in health care professional fields; they also remind families, schools, and the societies to strengthen the gender freedom and equality for male and female to devote in health care professionals.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132961254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"建置臺灣教學醫院新進營養師可信賴專業活動","authors":"黃孟娟 黃孟娟, 郭素娥 Meng-Chuan Huang, 金惠民 Su-Er Guo, 楊妹鳳 楊妹鳳, 陳珮蓉 陳珮蓉, 張惠萍 張惠萍, 周秋燕 周秋燕, 謝惠敏 謝惠敏, 張巧宜 張巧宜, 楊志偉 Chiao-Yi Chang","doi":"10.53106/199457952023051703008","DOIUrl":"https://doi.org/10.53106/199457952023051703008","url":null,"abstract":"\u0000 可信賴專業活動(entrustable professional activities, EPAs)是將多種核心能力整合成專業任務，可應用於醫療職場教學訓練，以信賴等級作為能力進展依據，供臨床工作授權參考。此專案針對接受衛福部二年期營養師訓練課程之新進營養師，建置教學醫院新進營養師EPAs。來自全國教學醫院臨床營養及營養學專家，以名義團體法進行共識及投票，建置七項EPA任務及其對應核心能力架構。EPAs任務為「住院病人常見疾病營養照護」、「門診病人常見慢性疾病營養照護」、「重症單位營養照護」、「醫院膳食盤餐督餐作業」、「盤餐膳食設計與食材成本管理」、「疾病飲食營養團體衛教」及「住宿型長照機構個案營養照護」。EPAs建立可將能力進展轉化為臨床營養工作授權，促進營養醫療照護品質提升。\u0000 Entrustable professional activities (EPAs) involve the integration of a variety of core competencies into professional practice tasks, and they can be applied for learning and training in the medical workplace. Supervision levels can help guide the development of competencies and are referenced for clinical work authorization. This paper describes the development of EPAs for entry-level dietitians in a postgraduate clinical training program established by the Ministry of Health and Welfare at teaching hospitals in Taiwan. Clinical instructors in dietetics and nutrition experts from across Taiwan were invited to participate in a consensus development conference, and the nominal group technique was employed to develop profession-specific EPAs. This project established seven EPAs, namely, nutritional care for inpatients with common diseases, nutritional care for outpatients with common chronic diseases, nutritional care in critical care units, hospital plate-meal preparation and supervision, meal design and cost management, group education for disease-specific nutrition, and nutritional care in residential long-term-care institutions. The establishment of EPAs can help transform such competencies into criteria for the authorization of clinical nutrition work in teaching hospitals and may enhance the quality of nutritional medical services.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134334052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"疫情中，透過遠距醫療的實務，看見分級醫療的價值","authors":"顏鴻順 顏鴻順, 張必正 Hong-Shun Yen","doi":"10.53106/199457952023051703005","DOIUrl":"https://doi.org/10.53106/199457952023051703005","url":null,"abstract":"\u0000 Covid-19 Pandemic 三年多來，台灣至今有超過1000 萬人確診，及1 萬多人不幸逝世！隨著病毒的突變，和防疫政策的調整，民眾、醫界乃至台灣社會都接受著不同的考驗和試煉。尤其是2022 年的Omicrone ，在半年多有超過1000 萬民眾的大規模感染。然而台灣的社會並沒有人心浮動，遑論社會動亂；經濟發展如常，GDP依舊上升。這除了台灣人民優異的健康素質，堅靭的醫界體系功不可沒！大醫院在原本急、重、難、罕的醫療照顧之外，更負責COVID重症病患的收治；基層醫療也不遑多讓，除了持續提供一般疾病、慢性病照護、疫苗接種之外，更承擔輕症確診者的遠距判讀、遠距診療及遠距居家照顧；醫院、診所分工合作，充分展現了分級醫療的價值，共同守護了台灣人民的健康，也成為全球的典範。\u0000 Since the outbreak of the COVID-19 pandemic 3 years ago, the total number of confirmed COVID-19 cases in Taiwan has exceeded 10 million and over 10,000 people have died from the disease. Following the mutations of the virus and the adjustments made to pandemic prevention policies, Taiwan citizens, the medical field, and Taiwan’s society have overcome and continue to face different challenges. During the prevalence of the Omicron variant in 2022, over 10 million citizens were infected within 6 months. Taiwanese people have shown unwavering resilience in the face of pandemic, let alone the possibility of social unrest. Instead, economic development continued as normal and Taiwan’s GDP continued to grow. In addition to Taiwan citizen’s excellent health literacy, the contributions of Taiwan’s firm and robust medical care system plays a crucial role in controlling the pandemic. Large-scale hospitals not only provide health care services for patients with acute, severe, difficult-to-treat, and rare diseases, but also shoulder the responsibility to receive and treat patients with severe COVID-19 symptoms. Similarly, the primary level of the medical care system not only continue to provide services, including offering care for common and chronic diseases and vaccination, but also contributing to the telemedicine diagnosis, treatment, and home-based care for patients with mild symptoms of COVID-19. The division of labor between hospitals and clinics comprehensively demonstrates the value of hierarchical medical care, which jointly safeguards the health of Taiwanese people and serves as a global paradigm.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121790010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"運用新版安全態度量表推展醫院韌性之迷思","authors":"莊秀文 莊秀文, 鐘國軒 Sheuwen Chuang, 邱仲峯 邱仲峯, 魏柏立 魏柏立","doi":"10.53106/199457952023051703010","DOIUrl":"https://doi.org/10.53106/199457952023051703010","url":null,"abstract":"\u0000 醫療機構對於病人安全文化的關注以及韌性/復原力的推動興趣穩步增長，2014年新版安全態度調查量表(簡稱新版量表)自原來的六構面擴增到八個構面，近年來此項調查每年收集全國超過11萬多名醫療作業人員的回覆，這是一項極為有用的資料。然而，新版量表的運用卻出現直接以「復原力」取代新構面「情緒耗竭」的迷思，且很多的應用是以相關性的分析為主，無法將分析結果帶入實際操作面使用。本文的目的即是引述多方專家論述與研究發現，釐清復原力/韌性、情緒耗竭、病安風氣、與韌性推動之間的關係，以導正此種迷思，並提出未來運用新版量表推動韌性的構想建議，以提升該調查的附加價值，協助醫院有效促進醫療機構韌性的推動。\u0000 Hospitals’ interest in promoting patient safety culture and resilience has steadily increased. The latest version (2014) of the Safety Attitude Questionnaire (SAQ) for assessing safety culture within health-care institutions was expanded from six to eight dimensions. This questionnaire has been used to collect responses from more than 110,000 health-care practitioners in Taiwan each year. However, the new SAQ dimensions are often misinterpreted, and some have claimed that hospitals or practitioners directly replace the “emotional exhaustion” dimension with a “resilience” dimension. However, most of these claims or applications are based on correlation analyses that cannot be implemented in practice. This paper dispels myths related to the dimensions of the new SAQ by clarifying the relationships among resilience, emotional exhaustion, safety climate, and resilience promotion based on theories and research findings. Additionally, this paper proposes utilizing the new SAQ to promote resilience, thereby enhancing the value of the instrument.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126115744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"通訊診療運用在居家照護的經驗","authors":"洪德仁 洪德仁","doi":"10.53106/199457952023051703006","DOIUrl":"https://doi.org/10.53106/199457952023051703006","url":null,"abstract":"\u0000 3年多來，由於COVID-19疫情肆虐臺灣，嚴重特殊傳染性肺炎中央流行疫情指揮中心、衛生福利部和全國醫療院所合作，提供輕症的確診個案居家照護，在COVID-19疫情期間，鬆綁通訊診療運用的法令限縮，最重要的關鍵就是通訊診療的大量運用。第一線診所的醫療護理人員應用LINE App資訊工具，和確診個案及家屬建立通訊診療，達到「以社區為基礎分級分流防疫模式」。以台北市為例，雖然是首善之區，也在這一次疫情中，醫療防疫提供者、地方衛生行政單位、確診市民等，共同學習資訊工具的應用，以視訊診療的方式，從而保存台灣的醫療量能，守護國民健康，更為台灣奠定發展視訊診療的重要基礎。\u0000 For over 3 years, Taiwan’s Central Epidemic Command Center, Ministry of Health and Welfare, and various medical institutions have collaborated to provide home care for mild but confirmed cases of COVID-19. During the pandemic, the key to the widespread adoption of telemedicine was the loosening of legal restrictions on its use. Frontline medical staff members in clinics used information tools on the LINE application to establish telemedicine communication channels with patients and their families, thereby achieving a “community-based triage and epidemic prevention model.” For example, in Taipei, health-care providers, epidemic prevention providers, local health administrative units, and patients with COVID-19 jointly learned how information tools could be utilized in the epidemic prevention efforts. Such video consultations enabled the preservation of Taiwan’s medical capacity, protection of national health, and, crucially, establishment of a foundation for developing telemedicine in not only Taipei but all of Taiwan.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"500 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132036947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"執行「偏遠地區遠距醫療建置輔導及資源盤點計畫」之成果初探","authors":"高曉霜 高曉霜","doi":"10.53106/199457952023051703002","DOIUrl":"https://doi.org/10.53106/199457952023051703002","url":null,"abstract":"\u0000 隨著科技導入及資訊化程度提升，遠距醫療已是多數國家醫療發展之趨勢，在全球疫情及法規放寬管制下更加速其擴展。衛生福利部（以下稱衛福部）於110年投入「偏遠地區遠距醫療建置計畫」（以下稱本計畫），藉由提供全國14個急重症轉診網絡適切的遠距醫療設施設備，增加遠距會診服務、優化區域聯防之轉診後送機制，期改善偏遠地區醫療資源不足問題。本文主要介紹由衛福部委託財團法人醫院評鑑暨醫療品質策進會（以下稱醫策會）就本計畫四大策略（包含遠距會診、綠色通道、安全轉診及區域聯防）進行之實地輔導暨盤點作業，並分享專家委員對於醫療機構合作模式及執行困難點之建議內容，希冀更多醫療機構合作參與本計畫，針對偏遠及醫療資源不足地區投入相關資源，共同提升偏遠地區醫療服務之量能及品質與可近性。\u0000 The increasing technological involvement and informatization in medical practice has contributed to the development of telemedicine in medical industries worldwide. Such development has been further accelerated and expanded as the COVID-19 pandemic receded and related regulations eased globally. Taiwan’s Ministry of Health and Welfare launched a telemedicine infrastructure construction project for remote areas (hereafter “the Project”) in 2021. In the Project, telemedicine infrastructure was established for 14 emergency and critical patient transfer networks across Taiwan to increase the availability of remote consultation services, optimize the medical evacuation mechanism for transfers in regional care networks, and address the insufficient medical resources in remote areas. The purpose of this study is to introduce the onsite coaching and assessment conducted by the Joint Commission of Taiwan in relation to the Project’s four major strategies (remote consultation, green corridors, safe transfers, and regional care networks). Another focus of this study is to share experts’ thoughts on the challenges medical institutions face in their collaboration models and execution of plans. The study is expected to encourage medical institutions to participate in the Project and offer medical resources in remote areas and areas with inadequate medical resources, thereby improving the medical capacity, quality, and accessibility in remote areas.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"35 15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116655663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"強化急重症網絡區域聯防之嶄新紀元-偏遠地區遠距醫療系統建置","authors":"林佩靜 林佩靜, 葉怡亨 Pei-Ching Lin, 蔡仲城 i-heng Yeh, 戴嘉言 Chung-Cheng Tsai, 陳綾穗 Chia-Yen Dai","doi":"10.53106/199457952023051703004","DOIUrl":"https://doi.org/10.53106/199457952023051703004","url":null,"abstract":"\u0000 隨著全國每萬人醫師數逐年上升，醫療資源仍集中於都會區域，偏遠地區緊急醫療資源仍相對不足。衛生福利部於2018年「通訊診療治療辦法」放寬遠距醫療之照護對象與模式，並在2021年正式將急診納入「全民健康保險遠距醫療給付計畫」給付範圍。遠距醫療在急重症病人照護已有實證應用，基於遠距醫療專科門診系統建置經驗，結合醫療與資訊科技發展，建置急診遠距醫療會診系統。在面臨緊急醫療搶救，急診遠距醫療須具備好的工具進行資訊傳遞，包含友善操作介面、即時且重要的醫療資訊交換、紀錄留存及綠色通道團隊預先啟動，並可提供大量傷患迅速應變支援，縮短急重症病人醫療處置等待時間。急診遠距醫療會診系統之建置已開啟創新之急重症就醫模式，惟系統功能仍須透過滾動式修正及持續教育訓練，使醫護人員熟悉操作並列入常規系統使用，以作為偏遠地區醫院急診病人第二意見諮詢及轉診評估，降低病人不必要之轉診，提升病人醫療品質。\u0000 Although the number of medical doctors per 10,000 residents in Taiwan has been increasing, most medical resources remain concentrated in metropolitan areas, and emergency medical resources in remote areas remain insufficient. In 2018, the Ministry of Health and Welfare passed the Rules of Medical Diagnosis and Treatment by Telecommunications to expand the coverage of people and models eligible for telemedicine services. In 2021, emergency services were included in the coverage of the National Health Insurance Telemedicine Benefits Plan. Telemedicine has been applied in emergency and critical care with empirical evidence. Based on the experience in establishing a telemedicine specialist outpatient system and the incorporation of medical and information technologies, a remote emergency consultation system was established. To ensure effective emergency care, an emergency telemedicine model must incorporate favorable tools for information transmission, including a user-friendly interface that facilitates real-time and critical medical information exchange and record keeping. The model should also allow for early preparation of the green channel team, ensure that support is at hand for rapid response to a large number of patients, and shorten the waiting time of emergency and critically ill patients for medical treatment. The establishment of the remote emergency consultation system has opened the door to an innovative emergency and critical care model. However, the system functions should be improved on a rolling basis, and continuous staff training is required to familiarize staff with the operation of the system as a routine system. Thus, the system can be used for second opinion consultation and referral assessment for emergency patients in remote hospitals, thereby reducing unnecessary referrals and improving the quality of medical care.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"IA-13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126556659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"環境清潔與抗藥性細菌","authors":"詹明錦 詹明錦, 彭銘業 彭銘業","doi":"10.53106/199457952023051703011","DOIUrl":"https://doi.org/10.53106/199457952023051703011","url":null,"abstract":"\u0000 環境清潔落實與否在預防和控制醫療照護相關感染方面扮演著重要的作用，首先，環境清潔可以減少病原體的存活和繁殖，特別是常見的抗藥性細菌。定期清潔和消毒病房、手術室、護理站等高風險區域，可以有效地減少微生物的存活和繁殖，同時減少醫護人員和病人接觸到病原體的機會，進而減少醫療照護相關感染的發生率，疾病管制署於104年11月公告醫療機構環境清潔感染管制措施指引，衛生福利部自105年病人安全目標六-落實感染管制，其執行策略：定期環境清潔機制，107年更具體地明訂需執行監測環境清潔品質。由此可見，落實環境清潔及有效之監測是感染管制非常重要的一環。目前常用於醫院環境清消品質監測的方式主要分為三類，包括：目視觀察評量法、螢光標示檢測法、微生物負荷殘留檢測法，已有許多文獻發表，透過前述的環境清潔監測方式可改善清潔人員環境清潔落實程度與降低細菌的移生及感染，因此醫療機構必須加強落實環境清潔，進行定期的消毒和清洗，以減少病原體和病菌的存活和繁殖。這可以減少病人感染病原體和病菌的風險，同時減少抗藥性菌株的傳播和擴散。\u0000 Environmental cleaning is key in preventing and controlling health care–associated infections. First, environmental cleaning can reduce the survival and reproduction of pathogens, especially those of common drug-resistant bacteria. The regular cleaning and disinfection of high-risk areas, such as wards, operating rooms, and nursing stations, can effectively reduce bioburden levels. An excellent cleaning environment reduces the risk of medical staff and patients being exposed to pathogens, thereby reducing the incidence of medical care–associated infections. Cleanliness is a goal of disease safety and an strategy for implementing infection control. Since 2017, various stipulations pertaining to the monitoring of environmental cleanliness quality have been implemented. The implementation of environmental cleaning and effective monitoring are crucial aspects of infection control and prevention. At present, the methods commonly used to monitor the quality of hospital environmental cleanliness can mainly be divided into three categories, namely visual observation, fluorescent labeling and detection, and microbial load residue detection. Numerous studies have explored the aforementioned environmental cleaning and monitoring methods and reported that they improved the quality of environmental cleaning by cleaning personnel and reduced bacterial colonization and the spread of bacterial infections or contamination. Accordingly, health care facilities must strengthen their environmental cleaning processes and conduct regular cleaning and disinfection to reduce the survival and reproduction of pathogens. These measures reduce the risk of patients contracting pathogens and the risk of resistant strains spreading.\u0000 \u0000","PeriodicalId":260200,"journal":{"name":"醫療品質雜誌","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125592290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}