門診病人大腸鏡檢查護理指導之改善專案

A Study for Improving the Nursing Instruction of Outpatient Colonoscopy

本專案旨在改善門診病人大腸鏡檢查之護理指導，增加病人對大腸鏡檢查的認知。調查發現門診接受大腸鏡檢查病人其腸道清潔程度為完全乾淨者僅42.4％，進一步資料呈現門診護理人員提供大腸鏡檢查前護理指導的完整率僅31.6％，門診病人對大腸鏡檢查的認知正確率為62.1％，而對護理指導滿意度為68.3％。分析後原因為：門診護理人員工作忙碌、專科知識不足、缺乏完整的大腸鏡檢查護理指導單張及護理指導標準。經專案小組介入後，建立大腸鏡檢查護理指導標準流程、製作大腸鏡檢查護理指導手冊、改由專案人員以電話提供衛教。經實施後，門診大腸鏡檢查病人護理指導完整率由31.6％提升為97.5％，門診病人對大腸鏡檢查認知正確率由62.1％提升為93.4％，病人對大腸鏡檢查護理指導之滿意度由68.3％提升為92.7％，且病人腸道清潔程度達完全乾淨為92.4％，顯示本專案確實能有效提升門診病人對大腸鏡檢查護理指導之作業品質，並可提供日後臨床護理照護標準修訂及參考，以提高照護品質。

The purpose of this project is to improve the quality of outpatient colonoscopy examination, by increasing patients’ awareness of the procedure via providing them thorough nursing instructions. The rate of adequately cleaning of large intestine before the colonoscopy examination was 42.4% among outpatient visits. Only 31.6% patients received complete colonoscopy examination instructions before the procedure. The accuracy of patients’ understanding of this procedure was 62.1%. Only 63.6% of the patients completed the preparation procedure before the examination. This led to a patient satisfaction rate of only 68.3% on the instructions given by nursing staff. There were several issues related to the problem, including lack of time of the nursing staff due to the busy nature of nursing care, short of a complete instruction booklet for colonoscopy examination, and lack of a standardized procedure for giving nursing instructions. To resolve these issues, the special task team has applied a three-step intervention, including setting up a standardized procedure for pre-colonoscopy nursing instruction, designing the educational booklets, and reminding patients of the procedure over the phone to reinforce their awareness. After implementation of the intervention, the accuracy of patients’ understanding of colonoscopy examination increased from 62.1% to 93.4%. The overall patient satisfaction increased from 68.3% to 92.7%. Over 92% of the patients had their large intestine completely prepared for the colonoscopy examination. The project showed that the intervention indeed reinforced the application of nursing instructions and could be a potential guideline for improving the quality of colonoscopy examination in outpatient settings.