降低居家護理個案非計畫性管路重置率之方案成效探討

The Effects of a Program for Reducing the Unplanned Catheter Replacement Rate among Home-Care Patients

目的：非計畫性管路重置是居家個案照護之重要議題，若未適當處理，可能導致嚴重的合併症。單位2010年7月至2011年6月間居家個案管路重複放置事件共129件，發生率為5.5%，因此提出改善方案，期望達以下目的：1.居家個案非計畫性管路重置率由5.5%降至閾值5.0%之下；2.主要照顧者管路照護技能正確率由58.0%提昇至80.9%。方法：為確認與管路重置有關因素，收集並分析事件發生居家個案特徵，並調查其中30位主照顧者之照護技能。依可行性、方便性、效益性及人力等原則，發展合適的方案。結果：專案內容包含：修訂居家個案非計畫性管路重置標準流程及相關的護理指導單張以及檢核表、製作外語衛教單張並增加圖片，使外籍看護照護時能有所依據，此外舉辦居家護理師「管路照護及防範滑脫」在職教育課程，藉腦力激盪出各種約束替代方案，並要求居家護理師確實與照顧者討論可行的約束替代方案。方案介入後，非計畫管路重置率由5.5%明顯降至3.6%；主要照顧者管路照護技能正確率由58.0%提升為85.7%，顯著促進主要照顧者處理管路的能力。結論：本方案可有效降低居家個案發生非計畫性管路重置比率，以促進管路照顧的品質。

Objective: Regarding the problem of unplanned replacement of catheter, it is an important issue which has frequently occurred in home care patients. If it were not able to handle properly, it may lead to serious complications. There were 129 home-care patients who had occurred unplanned replacement of catheter (the rate was 5.5%) during the period from July, 2010 to Jun, 2011. A program was thus developed in order to propose improvement plan to achieve two purposes: 1. decrease the rate of unplanned replacement from 5.5% to 5.0%, 2. the main caregivers care skills correct rate increased from 58.0% to 80.9%. Methods: In order to identify the related factors of unplanned replacement of catheter, 30 caregivers had been sampled from those home-care patients and surveyed their care abilities. According to the principles of practical, convenient, benefit and manpower, we generated a feasible program. Results: The program included revising a standard process, care instruction sheet, and checklist of assess unplanned replacement. In addition, we designed the pictured instruction with Indonesian version, so that foreign caregivers can be according with it. In addition, the home care nurses took some course about “Pipeline Care and Prevent Slippage” to brainstorm many kind of alternatives of restraint, and discuss with caregivers which were possible in use. After the intervention, the rate of unplanned replacement significantly decreased from 5.5% to 3.6%. It dominantly promoted the abilities of caregiver in taking care of those patients’ catheter. Conclusion: This program could significantly decrease the rate of unplanned replacement for home-care patients who are with catheter. In addition, it could promote the quality of care in handling the catheter for caregiver.