提升加護病房護理指導完整率之專案

Project of enhancing complete rate of a nursing guide in the intensive care unit (ICU)

在疾病複雜度高且探視時間受限的加護病房，提供照顧者完整的護理指導是有困難的，2012 年度本單位轉出後重返的11 例病人，皆因照顧者照護技巧不當而延長住院天數，病人穩定轉出後卻未能延續安全的照護，使同仁感到失落及不捨，照顧者照護能力攸關著病人安全，故成立專案小組改善。經查檢發現護理指導完整率僅45％，分析確立問題為：會客時間工作忙碌無暇分身、缺乏護理指導標準流程、缺乏護理指導教材。組員參考文獻、發揮創意擬定對策，評估臨床可行性包括：制訂加護病房護理指導標準流程、適時啟動支援機制合併使用護理指導追蹤看板、應用教材模型回覆示教、手創Q 版人型管路介紹圖、制訂及執行護理指導記錄表並列入交班，經由實施改善對策後，加護病房護理指導完整率由45%提升至78.8%，也提升家屬參與病人安全照護及護理團隊為照護品質改善的凝聚力，盼此專案之改善可做為其他相同屬性單位之參考。

Due to complicated diseases and limited visiting hours in the intensive care unit (ICU), offering complete nursing care guidance to caregivers is quite difficult. In 2012, caregiver’s inappropriate caring skills caused 11 patients to return to the ICU and also prolonged length of stay. The ICU nurses were disappointed and felt helpless that even though patients were transferred to wards steadily, they were unable to be cared for safely and continuously. Therefore, the task force was established to improve the caregivers’ abilities of taking care of patients. The investigation indicated that nursing guidance complete rate was only 45%, and found out the following problems: nurses were too busy to instruct at the visiting hours, there was a lack of standardized procedures of nursing guidance, as well as lack of authentic materials of nursing instruction. The task force studied the references and made five strategies to execute, which included setting up standard procedures of nursing guidance in the ICU; properly initiating a backup mechanism if the primary nurse was unable to teach; applying a baby model and Q version design of invasion tubes as materials to demonstrate the specific caring techniques and asking the caregivers to perform in turn; and utilizing the record sheet to hand over to the next shift in the meanwhile using a track board in order to follow-up the process. The nursing guidance complete rate steadily rose from 45% to 78.8% after carrying out these strategies. It also promoted the families to participate in patient safety care and strengthened cohesion of the whole team to improve caring quality. The authors wish other units would adopt such methods to improve patient safety care.