加護病房護理人員更換呼吸器管路過程標準化

The Standardization of the Procedures of Changing Ventilator Circuits Implemented by Nurses in Intensive Care Unit

本專案旨在教導護理人員判定並採取適當更換方式，以減少病患在更換呼吸管路時不適或意外發生，並對操作程序加以標準化，以減少更換過程中污染管路情況，進而達成具品質的醫療照護。 改善方法包括 1. 參考 Ely 等人（ 1996 ）提出的六項評估病患可否脫離呼吸器之指標，使護理人員能採取適合的呼吸器管路更換方式。 2. 舉辦在職教育，加強宣導。3. 訂定明白、清晰的書面準則，及製作「標準更換呼吸器管路程序」工作手冊。本專案的成效評估結果發現改善方案實施後，護理人員在評估病人、準備用物、執行、及評價等四方面確實較改善方案前有明顯進步，但因評值期過短及監測頻率太少，以致部份目標並未達成，顯示需要再訓練、教導及持續監測，以期能達到本專案之目的。This quality improvement project aims to help nurses to provide safe, competent, and effective care in changing ventilator circuits. Three methods, which include six screening indicators, education programs, and developing astandard written procedure, were used. Compared with previous practice that is, a word-of-mouth standard, nurses improve their assessment of patients' conditionbefore undergoing procedures, preparation of ventilator circuits, changing thecircuits, and evaluation of patients' condition after the procedures. However, because there are limits to the duration and frequency of evaluations, it cannot be clearly ensured that the process standard is met by all of nurses in amedical intensive care unit. Quality, assurance team members and nursingadministrators should arrange ongoing education, further practice, andcontinuous evaluation. It is anticipated that such efforts will achieve each ofthe goals of this project.