提升執行介入性心導管治療病人術後照護之完整性

Improving the Quality of Nursing Care for Patients Receiving Interventional Catheterization

以往本院行介入性心導管治療術後會轉至加護病房拔除動脈鞘管、止血等處置穩定後返回普通病房。2010 年起配合醫院政策，行介入性心導管治療病人術後直接返病房，護理人員對即刻護理倍感壓力，因無照護經驗且專案未實施前照護完整性僅38%。主要問題為：缺乏教育訓練及認知不足、缺乏工作指引及查核表、不熟悉Femostop 止血加壓器操作、缺乏標準盤。專案小組擬定改善對策:一、制定照護常規並舉辦在職教育；二、製作照護流程圖及查檢表；三、製作Femostop 標準處理作業規範及標準盤。改善措施實施四個月後，不但提升護理人員專業知能，介入性心導管治療病人術後照護完整性也提升到92%，確保照護品質及病人安全。

According to the hospital's policy, patients were sent to the Coronary Care Unit for close observation, catheter sheath removal, and bleeding checks after receiving interventional catheterization. In 2010, because of changes in health insurance programs, our hospital's policy was also modifi ed. Patients were directly returned to general wards after interventional catheterization, substantially increasing the stress and workload for nurses in these units, and the completion rate of postprocedural care was only 38% before the project. The main problems were nurses’ lack of continuing education and familiarity with Femostop operation as well as the lack of postinterventional catheterization care guidelines, checklists, and standard rules of usage. Therefore, the quality control team took the following actions: 1. Established postinterventional catheterization standards of care and implemented on-job training, 2. established a standard-of-care fl ow chart and checklist, and 3. established a Femostop operation fl ow chart and standard rules of usage. After 4 months, the quality of postinterventional catheterization nursing care improved significantly. The completion rate of postprocedural care was increased to 92%. In conclusion, this project improved general ward nurses’ knowledge and skill the quality of nursing care, and patient safety and satisfaction.