• 제목/요약/키워드: 표준진료지침서

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CT 조영제의 부작용 예방을 위한 표준진료지침서의 개발과 적용 (Development and Implementation of a Critical Pathway for Prevention of Adverse Reactions to Contrast Media for Computed Tomography)

  • 장근조;김명구;유병규;권대철
    • 대한방사선기술학회지:방사선기술과학
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    • 제30권1호
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    • pp.39-46
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    • 2007
  • CT 조영제의 부작용을 예방하여 환자만족도와 방사선사 및 간호사의 업무만족도를 향상을 위해 표준진료지침서를 개발하고 적용하였다. 표준진료지침서 개발은 팀으로 구성하여 단계적으로 실시하였다. 대상은 환자 및 방사선사와 간호사를 대상으로 만족도를 평가하였다. 표준진료지침서를 적용하는 군이 만족도가 높게 조사되었고, 방사선사와 간호사는 표준진료지침서를 적용하는 경우 환자의 조영제 부작용 정보를 사전에 파악하는 효과와 조영제 부작용을 예방 효과가 있어 만족도가 증가하였다. 조영제 부작용은 표준진료지침서를 적용하기 전 90명에서 적용 후 66명으로 감소하는 효과가 있었다. 표준진료지침서를 적용하여 환자 정보제공(24%), 조영제 예방효과(19%), 조영제 부작용의 사전 인지효과(39%), 지식정도(19%)로 업무 만족도 향상 효과가 있었다. 혈관외유출은 표준진료지침서 적용전은 13건이었고, 적용 후는 6건으로 감소하였다. 혈관외유출 위치와 조영제 용량을 종합의료정보시스템(HMIS)에 입력하여 혈관외유출 예방과 검사 만족도를 높이는 효과가 있다. 환자 정보를 파악하여 조영제 부작용 예방효과와 처치로 의료 질 향상 및 만족도 증가하였다. 표준진료지침서를 지속적으로 적용하여 환자, 검사자의 만족도 및 의료질을 증진하도록 한다.

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방사성옥소 치료를 위한 표준 지침서 개발과 치료병실 환경 개선 연구

  • 김봉수;표성재;김창호;조용귀;신채호
    • 핵의학기술
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    • 제12권1호
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    • pp.126-129
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    • 2008
  • 목적: 방사성옥소 치료 환자들은 주의 사항이나 식이요법 등을 지키는 것에 대한 어려움과 3~4일간의 격리 치료기간 동안의 막연한 불안감을 느끼는 등의 심리적, 신체적 부담감을 가지고 있다. 본 과에서는 방사성옥소 치료의 예약과 치료병실에 대한 표준지침서를 개발하여 환자들에게는 정확하고 쉬운 정보를 제공하여 막연한 불안감을 해소하고 치료 업무에 종사하는 종사자들에게는 통일된 정보를 제공하여 업무효율을 향상시키는 효과와 치료 병실의 환경개선을 통한 환자의 심리적 안정감을 찾는데 주력하고자 본 연구를 시작하였다. 대상 및 방법: 2006년 9월부터 2007년 2월까지 치료병실에 입원한 환자를 대상으로 치료환자의 치료 일정, 주의사항, 저옥소 식단과 치료병실의 표준 진료 지침서를 개발하고 치료 병동의 간호사와 협력하여 치료병실의 환경을 개선하여 환자에게 적용하였다. 결과: 방사성옥소 치료의 특성상 환자는 치료가 결정되는 순간부터 치료과정에 대한 이해도 부족과 치료병실 생활에 대한 불안감을 느끼게 되므로 치료 시 사용되는 일정 및 주의사항, 저옥소 식단의 표준지침서를 개발하여 환자 치료병실 개선과 치료병실에서의 표준지침서를 개발하고 사용하였다. 결론: 치료에 따른 진료지침서와 병실 환경을 개선 후 치료에 대한 환자의 이해도 및 치료병실에서의 생활이 예전과 비교해서 많이 향상 되었고 치료의 과정을 설명하는 예약 시에도 많은 도움이 되고 있다. 이러한 치료과정의 규격화 하는 작업들은 본원뿐 아니라 치료병실이 있는 병원의 치료환경을 개선하는데 도움이 될 것이라고 사료된다.

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협회소식

  • 한국방사성동위원소협회
    • 동위원소뉴스
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    • 2호통권50호
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    • pp.2-5
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    • 2001
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액취증 환자에서 표준 진료지침서의 개발과 적용 (Development and Implementation of a Critical Pathway in Patient with Osmidrosis)

  • 김양우;김흥규;심경원
    • 한국의료질향상학회지
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    • 제9권1호
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    • pp.66-73
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    • 2002
  • The current health care system demands provisions for patient care in perspectives of a cost-effectiveness and patient satisfaction. Critical pathway implementation facilitates optimal sequencing and intervention timing of patient care, and makes medical team and patients participate in a treatment actively. In this study, a critical pathway was developed and implemented to patients with osmidrosis who undertake operation. Sixty patients were included in the study. The critical pathway was implemented for care of 26 patients while the traditional care was implemented for 34 patients. In the critical pathway implemented group, time needed for charting and unessential working was reduced. Mean time amount of time for patient nursing was increased. The critical pathway implementation is an effective method to utilize time of medical team. Also it increases the satisfaction index of patients and medical team simultaneously.

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자연기흉으로 폐기포절제술을 받은 환자를 위한 표준진료지침서 개발 (Development of a Critical Pathway of Bullectomy for Spontaneous Pneumothorax Patients)

  • 김미경;유승흠;이두연;손영모
    • 한국의료질향상학회지
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    • 제9권1호
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    • pp.34-51
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    • 2002
  • Background : The purpose for this study is to develop a critical pathway of bullectomy for spontaneous pneumothorax patients. Methods : For this study a conceptual framework of critical pathway was developed through a review of the literature including five critical pathways which are currently being used in USA, and opinions of the critical pathway development team members at Y university hospital. In order to identify the service contents required by these patients and to draw up a preliminary critical pathway, 33 cases of medical records of patients who had received bullectomy for spontaneous pneumothorax between September, 2000 to August, 2001 at the Respiratory Center of Y university hospital in Seoul was analyzed. Results : In order to test the clinical validity of the preliminary critical pathway, it was applied to ten patients who had received bullectomy for spontaneous pneumothorax from October, 2001 to December, 2001. The average discharge day was 4.89th post operation day, six patients discharged on the fourth post operation day which was the expected day, one patients discharged one day earlier than the expected day, one patient discharged three days later than the expected day, and one patient discharged six days later than the expected day. There were variances between the critical pathway and the actual practice. The variances came from tests, medications, and treatments. One item that showed variance in clinical applications was complemented, and three items were decided not to be corrected for the final determination of the critical pathway. Conclusion : This critical pathway is applicable to the care of patients with bullectomy for spontaneous pneumothorax, but it needs more clinical applications to grasp varied variances.

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표준 진료 지침서(Critical Paths) 개발에 관한 연구 - 충수절제술(Appendectomy) 환자용 - (Development of Critical Paths for Appendectomy)

  • 김용순;박지원;박연옥;조은숙;김명욱
    • 한국의료질향상학회지
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    • 제2권2호
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    • pp.32-45
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    • 1996
  • Background : A critical path defines an optimal sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to better utilize resources, maximize quality of care, and minimize delays. It can be thought of as a visualization of the patient care process. In this study, a review of appendectomy patient records was undertaken to identify a critical path for the management of this treatment. Methods: For this study, records of patients under 15 or over 65 years of age were excluded ; cases where the patient was pregnant, or where complications developed were also excluded. The remaining 21 cases were divided into two categories according to the indication for appendectomy : for acute appendicitis, and for perforated appendix or drainage of periappendical abscess. The time frame for the review was from patient examination immediately prior to operation, through discharge. The study team was composed of a surgeon, research head nurse, education head nurse, surgical part head nurse, and medical recorder. Following their review of the 21 charts, the team determined an appropriate progression and schedule for an appendectomy. Result : Through the chart and literature review, the following aspects of the care process were identified as typical and tracked : monitoring/assessment, treatment, lines/drains, medication, activity, diet, tests and patient education. Conclusion : From this study, the design team determined two separate critical paths : one for appendectomy only, and one for appendectomy plus drainage. Next, these paths must be validated and fine-tuned through clinical implementation. In addition, a comparison of our design with the critical paths determined at other hospitals would be extremely valuable for advancing research in this area. Lastly, the critical path approach to improving patient care and maximizing hospital resources should be applied to other procedures.

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최근 5년간의 국내.외 표준 진료 지침서(Critical Pathway) 연구논문분석 - 1995~1999년 - (The Analysis of Studies about Critical Pathway in Domestic and Abroad - From 1995 to 1999 -)

  • 김용순;박지원;김기연
    • 한국의료질향상학회지
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    • 제7권2호
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    • pp.156-167
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    • 2000
  • Background: Emphasis in healthcare during the 1990s has been to provide both optimal wellness and function with quality in a Cost-effective manner. Critical pathway was developed to meet the need to guide clients along the continunm of care and to achieve continuity of care. The purpose of this study is to review and analyze articles related to the critical pathway that had developed and applied in Korea and abroad from 1995 to 1999. Methods: Total 39 studies were analyzed in terms of group of application, need of development, horizontal axis: time frame, vertical axis : items of care, task force team, identification of preliminary critical pathway, validation of preliminary critical pathway, types of final critical pathway, a person who coordinates and effects on critical pathway. Results: In the aspect of group of application, there were various diseases in the overseas than in Korea. In domestic and overseas, the horizontal axis included mainly the time from the start of hospitalization to discharge and vertical axis of the critical pathway included commonly the following nine items : tests, diet, medications, consultations, activity, assessments, treatments, education, discharge planning. Preliminary critical pathway was mainly drawn up through chart review in both. Types of final critical pathway were mostly for medical team use in Korea and were for medical team and patient use in abroad. A person who coordinates critical pathway was mostly nurse in abroad. There was positive effects on critical pathway in both. Conclusion: Staff education and information about critical pathway are needed to use it effectively.

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중풍변증표준안 진료기록부 임상적용을 위한 증례기록부와 표준작업지침서의 개선과정 (Improvement of Tentative Korean Standard Differentiation of the Symptoms and Signs for Stroke for Clinical Application)

  • 이민구;강병갑;김보영;고호연;최선미;설인찬;조현경;윤종민;문병순;이인
    • 동의생리병리학회지
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    • 제21권1호
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    • pp.347-351
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    • 2007
  • This study was done to report the improvement of second case report form(CRF) and standard operating procedure(SOP) of Tentative Korean Standard Differentiation of the Symptoms and Signs for Stroke. We were in charge of developing case report form(CRF) and educating the investigators. In the process of this project, we needed to develop standard operating procedure(SOP) for this CRF. So we made Tentative Korean Standard Differentiation of the Symptoms and Signs for Stroke and tried clinical application at Department of Oriental Internal Medicine of Wonkwang University and Daejeon University in 2005. And in this pilot study we can find out some problems and need to improve it. We strengthen the incision and exclusion criteria of CRF We canceled the Chief complains entry for efficiency. We reflected the decision of Stroke standard committee. We reduced the differentiation index of CRF to promote efficiency and accuracy. We rearranged the order of the differentiation index to promote rationality and practicality. We regulated detail item belonging to Differentiation index. We used a colloquialism in question. We inserted flow chart in SOP. We inserted picture of diagnostic index.

정상산모의 질식분만 및 제왕절개술에 대한 표준진료지침서의 개발과 임상 적용 (Development and Clinical Application of Critical Pathways for Vaginal Delivery and Cesarean Section)

  • 박용원;배상욱;정영내;이혜우;김영란;홍순복;박현주;탁관철
    • 한국의료질향상학회지
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    • 제7권1호
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    • pp.32-45
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    • 2000
  • Background : Critical pathway is an optional sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to minimize delays and resource utilization, and to maximize quality of care; abbreviated versions of case management plans that show critical outcome and key incidents that occur in a predictable and timely fashion to achieve an appropriate length of stay. This study is to develop a critical pathway for vaginal delivery and cesarean section to assess the degree of contentment of the patients and medical personnel and to implement clinical application to see how we could meet the need to guide patients to achieve continuum of care. Method : Critical pathways were developed for normal vaginal delivery and casarean section. LOS(length of stay) target for vaginal delivery was 1 day after delivery & 5 days after C-section. It was distributed to the mother at the OPD and explained thoroughly. It was applied when patients got into the Labor & Delivery Floor. We applied total of 42 patients (30 normal deliveries & 12 C-sections) from February to March, 2000. We performed patient satisfaction survey to all 42 patients, 24 nurses, and 7 residents for internal customer satisfaction. Results : Twenty six patients out of 42 responded to the survey. Twenty one patients out of 26 answered satisfactory. Eighty four percent of 21 respondents replied Critical pathway worked very well. Treatment column got the most compliance. Eleven out of 31 employees thought critical pathway is very helpful for the patient care. Eighteen people didn't see any difference. In their opinion, treatment got the least compliance, which is the contrary to patients opinion. Fifty eight percent of respondents thought that critical pathway can expedite early discharge. Conclusion : Patient satisfaction was higher than we expected but we still need to revise the form. It is recommended to analyze the cost and variance check in the future.

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