某加護病房呼吸器相關肺炎(VAP)照護改善專案

A Project to Improve the Quality of Nursing Care for Ventilator- Associated Pneumonia Patients in an ICU

呼吸器相關肺炎(Ventilator- Associa ted Pneumonia;VAP)是加護病房常見院內感染之一，照護不正確容易造成肺炎，導致病人死亡與住院天數增加。本單位發現呼吸器相關肺炎照護正確率低於75.8%，因此，成立專案小組，希望透過專案提升認知及照護正確率並降低感染率。本專案小組自2008年7月1日成立，分析照護不正確原因為（一）人員方面：護理人員認知不足；（二）制度方面：無訂定呼吸器相關肺炎(VAP)照護標準規範、欠缺稽核制度；（三）物方面：抽痰與噴霧藥劑用具無固定擺放、缺統一放置盒。經7個月，專案改善措施包括舉辦呼吸器相關肺炎(VA P)照護在職教育；制定照護標準規範與稽核、獎懲；制定統一放置盒、固定用具擺放位置。專案執行結果認知由69.8分提升至94.6分，正確率由75.8%提升至96.7%，感染率2.36‰降至1.7‰，顯示本專案能有效改善呼吸器相關肺炎(VAP)照護品質。

Ventilator-associated pneumonia (VAP) is a common nosocomial infection in intensive care units (ICUs), and inadequate nursing care can lead to high mortality and prolonged hospital stays for such patients. A previous evaluation on our unit found that the rate of adequate nursing care for VAP patients was 75.8% , so the aim of this study was to upgrade knowledge, improve the adequacy of nursing care, and reduce the infection rate for VAP patients in our unit. The project was established on July 1, 2008. First we determined the causes of inadequate nursing care to be: (1) inadequate knowledge on the part of the nursing staff, (2) lack of standard care guidelines for VAP patients, and (3) inappropriate appliances such as fixed devices or boxes for suction and nebulizing equipment. In response to the shortcomings, we: (1) conducted education and training programs about VAP, (2) developed standard care guidelines for VAP, (3) established a reward and punishment policy and followed it, and (4) made uniform devices for suction and nebulizing equipment. The project significantly increased knowledge about VAP in our nursing staff (from 69.8 to 94.6 points), improved the rate of adequate nursing care (from 75.8% to 96.7%), and reduced the infection rate in our VAP patients (from 2.36% to 1.7%). In conclusion, the project efficiently improved the quality of nursing care for VAP patients in our ICU.