# 夜班護理師接到值班醫師之電話醫囑：「疼痛時靜脈嗎啡4毫克每2小時」。哪一行動展現正確之閉環溝通？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=373130&lang=zh-tw  
> language: zh-TW  
> subject: NCLEX-RN  
> category: MOC

## 題目

夜班護理師接到值班醫師之電話醫囑：「疼痛時靜脈嗎啡4毫克每2小時」。哪一行動展現正確之閉環溝通？

## 選項

1. 於EHR記錄「morphine 4 mg IV q2h prn pain」後執行下一劑投與。
2. 對醫師逐字覆誦醫囑請其確認：「morphine four milligrams IV every two hours as needed for pain — 請確認」。確認後再輸入並執行。 **✔ 正確答案**
3. 請主責護理師於第二支電話旁聽，由兩位護理師共同見證醫囑。
4. 拒絕所有夜班期間之電話醫囑，要求醫師於白天再撥電話。

**正確答案: 2**

## 解析

Joint Commission病人安全目標要求所有口頭/電話醫囑READ-BACK：寫/輸入醫囑、向醫師覆誦、確認後再執行。數字應逐位讀出(「four milligrams」而非「4 mg」)以避免「fourteen」與「forty」聽錯。未覆誦即輸入(1)違反安全政策。兩護理師同聽(3)非標準作法。拒絕電話醫囑(4)不切實際且無政策支持。

## 深入解析

閉環溝通標準為RECEIVE → WRITE → READ-BACK → CONFIRM。數字應逐位發音(「one zero」而非「ten」)以避免聽錯。部分醫院亦要求將醫囑輸入EHR，由醫師於24小時內電子簽核。

## 臨床情境

夜班，術後疼痛病人。值班醫師下達嗎啡之**電話醫囑**。單位政策與Joint Commission病人安全目標要求所有口頭/電話醫囑進行**覆誦驗證**。

## 重要概念

- **閉環溝通** — RECEIVE → WRITE → READ-BACK → CONFIRM後依口頭/電話醫囑行動。
- **Joint Commission NPSG** — 國家病人安全目標要求所有口頭/電話醫囑之覆誦驗證。
- **逐位覆誦** — 逐位讀出每個數字(例：「four zero」而非「forty」)以防聽錯。

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