提升護理人員動靜脈瘻管穿刺技術之正確率

A Project to Increase the Accuracy of AV Fistula or Graft Puncture

本專案旨在提升血液透析護理人員動靜脈瘻管穿刺技術的正確率。2006年11月至2007年8月動靜脈瘻管穿刺技術正確率品管監測，正確率僅介於58.8至68.6%之間，以持續品管稽核、推動瘻管穿刺技術標準化流程，護理同仁接受相關教育訓練，但瘻管穿刺技術正確率僅達87.9%，透過特性要因分析，找出單位需解決問題護理人員消毒方法不正確、記錄不完整、穿刺前未確定瘻管功能，以及穿刺前未洗手。運用PDCA循環艏法與決策矩陣法，執行解決方案包括各區設置洗手檯、每床設置乾洗手液並以科室公費購買滋潤護手霜、安排教育訓練與讀書報告、於科會進行異常事件分析、進行動靜脈瘻管穿刺技術與洗手情境品管稽核、將品管稽核結果列入榮譽榜與個人考核，以及推動主護護理照護模式。結果動靜脈瘻管穿刺技術正確率由2007年8月改善前的59.4%提升至2009年5月改善後的100%。

The aim of this project was to improve the accuracy of AV fistula or graft punctures for nurses. Data analysis showed that the accuracy of AV fistula or graft punctures was just 58.8% to 68.6%. For nurses, AV fistula or graft puncture is a routine task. Despite the implementation of quality control management monitoring, standardization of AV fistula or grafts puncturing instrument management protocols and continuing education for nurses, the accuracy of AV fistula or graft punctures was still only 87.9%. We used root cause analysis and a decision-making matrix to identify the most urgent problems. The four main problems requiring improvement were the improper disinfection procedures before AV fistula or graft puncture; improper record keeping; failure to confirm AV fistula or graft function; and hand hygiene before making the puncture. The Plan-Do-Check-Act (PDCA) cycle was applied and multiple intervention strategies implemented, including provision of sufficient handwashing facilities, quality audits on AV fistula or graft puncturing technique, quality audits on hand-washing facilities, including the quality audit results into a honor roll and personal performance reviews, and promoting an active nursing care model. The average accuracy rate was increased from 59.4% in August 2007 to 100% by May, 2009.