提昇護理人員執行剖腹產臨床路徑之完整率

Methods to Improve the Completion of Nursing Clinical Pathway for Caesarean Section

臨床上常遇到剖腹產個案於出院時，詢問如何執行傷口照護？何時可以開始執行性生活？護理人員若未能即時依據剖腹產個案需求提供適切之衛教內容，將影響個案返家後的自我照顧能力。本專案係針對護理人員執行剖腹產臨床路徑之缺失加以改善。經現況分析後發現其缺失原因為：「剖腹產臨床路徑」表內容完整率偏低僅39.9%、剖腹產臨床路徑衛教項目及衛教單張不一致、欠缺剖腹產臨床路徑表單補充流程、缺乏剖腹產臨床路徑監控流程、護理人員對剖腹產臨床路徑執行方法不一致、護理人員對剖腹產臨床路徑平均認知程度低，僅61.3%。針對上述缺失擬定改善對策：1.修訂「剖腹產臨床路徑」表內容。2.製作「剖腹產照護－－產婦篇」衛教單張。3.製訂剖腹產臨床路徑表單補充流程。4.製訂剖腹產照護臨床路徑監控流程。5.製作剖腹產臨床路徑照護指引。6.舉辦剖腹產臨床路徑效益與應用說明會。經改善措施實施後，護理人員執行剖腹產臨床路徑之完整率由39.9%提昇至73.1%、護理人員對剖腹產臨床路徑平均認知程度由61.3%提升至95.9%，均達專案目的，顯示透過完善的臨床路徑規劃及落實臨床護理指導，確實能提升病患照護品質。

Upon being discharged, postpartum women often asked questions about “How do I care the wound?” or “When may we start sexual behavior?” Insufficient instruction often affected the quality of home care. The purpose of this project was to improve the incompleteness of performing Caesarean section (C/S) clinical pathway. After clinical analysis, the content completion rate was only 39.9%. The major factors of the incompleteness were inappropriate time schedule, inconsistency between nursing instruction in clinical pathway and health education materials, shortage of the clinical pathway sheets, lack of continuous monitoring, deficiency of nursing recognition about clinical pathway, and discordant performance of clinical pathway. In order to resolve the problems, methods included revising the content of clinical pathway, developing the nursing instruction sheets for C/S postpartum women care, establishing supplementary procedure, monitoring process and nursing care guidelines for C/S clinical pathway, and holding seminar to introduce the benefits and applications of the pathway. The results indicated that the completeness of C/S clinical pathway performed by nurses increased from 39.9% to 73.1%. Moreover, the nurses’ recognition of clinical pathway improved from 61.3% to 95.9%. The goals of the project were successfully achieved. The quality of patient care could also be improved.