某教學醫院加護病房周邊靜脈炎發生率改善方案

A plan to decrease the incidence rate of peripheral phlebitis in the intensive care unit of teaching hospital

本專案旨在某教學醫院加護病房周邊靜脈炎發生率改善方案，經統計發現本單位2006年1月至6月之周邊靜脈炎月發生率為6.0%，病人因周邊靜脈炎而造成感染並延長住院時間，故依文獻針對護理人員執行靜脈輸液留置的過程及周邊靜脈炎報告單進行訪查，發現有：未落實無菌技術、注射部位不適當、靜脈穿刺技術不純熟、病人本身高感受性。因此於2006年7月起實施改善措施：宣導周邊靜脈炎影響病情的重要性、與感控室合作宣導洗手、進行周邊靜脈炎專題報告及筆試、提供靜脈穿刺技術練習、成立「靜脈穿刺技術」教學及考核小組、將高感受性病人列入交班、監測發生率，並舉辦中央在職教育。自2006年12月至2007年4月止，平均每月周邊靜脈炎發生率降為2.2%，目標達成率126%，期望藉此減少病人合併症、增進照護品質。

The purpose of this project was to decrease the incidence rate of peripheral phlebitis in the intensive care unit of teaching hospital. Peripheral phlebitis is the most common complication in peripheral intravenous infusion. The statistical incidence rate of peripheral phlebitis in our unit was 6.0%. If these patients would be infected, their duration of hospitalization would be prolonged by peripheral phlebitis. Therefore, we decided to investigate the causes of peripheral phlebitis in our unit. Finally, we discovered they included: (1) Nurses didn’t complete the detailed steps necessary to the procedure of techniques of sterilizing; (2) Nurses selected inappropriate insertion sites; (3) Nurses were unskilled with the peripheral veinpuncture technique; (4) Some patients were highly sensitive. Since July 2006, the strategies used include; (1) Arrange guidance about how peripheral phlebitis could influence patient’s condition; (2) Make a coordination with infection control unit guide to hand washing; (3) Hold study reports and tests which were related to peripheral phlebitis; (4) Provide a practice chance for the procedure of inserting peripheral intravenous and discuss it; (5) Establish an inspection group for the peripheral veinpuncture technique; (6) Pass on the highly sensitive patients to the next nursing shift; (7) Monitor the incidence rate; (8) Conduct the central in office education. By April 2007, the monthly average incidence rate of peripheral phlebitis decreased from 6.0% to 2.2%, which the level of goal reaching 126%. We expect these strategies could reduce patient’s complication and improve the quality of nursing.