兒科加護病房病人放置葉克膜護理流程完整性之改善方案

Nursing Approaches to Improve Extracorporeal Membrane Oxygenation (ECMO) Care in a Pediatric Intensive Care Unit

背景：由於醫療科技的進步，體外維生系統（extracorporeal membrane oxygenation, ECMO），亦稱葉克膜，現今在加護病房應用日益頻繁。統計本院2009年使用葉克膜救治個案共有26人，其中18歲以下個案共4例（15.4%），由於個案數不多，致單位護理人員照護時壓力大、經驗及熟練度不足，因而成立專案小組探討葉克膜照護之相關問題。目的：（1）提昇葉克膜放置前用物準備醫囑開立完整性達98%。（2）減少用物準備耗時少於60分鐘。（3）提昇護理人員對葉克膜照護認知準確性達99%。解決方案：實施的介入措施有：「規劃葉克膜專用工作車」以提升臨床工作便利性及安全性；「制訂葉克膜導路放置準備檢視表」以提高管路放置完整性減少耗時；「舉辦葉克膜照護在職教育」以提升護理人員葉克膜照護認知及技能；「訂定葉克膜見習制度」以增加護理人員葉克膜照護經驗，減少不熟練所致之疏失。結果：本專案實施後，葉克膜放置前用物準備醫囑開立完整性由25%增加到100%；葉克膜放置前用物準備時間由90分鐘縮短到40分鐘，護理人員對於葉克膜照護完整性由51.2%提昇到99.2%，均達專案目標。結論：顯示專案實施後能有效的減少葉克膜放置準備時間及作業流程之完整性，提昇護理人員對於葉克膜照護知能之準確性，完善單位中葉克膜照護品質。

Background: Medical technology advances have led to the increasingly frequent use of extracorporeal membrane oxygenation (ECMO) in intensive care unit applications. Four of the 26 patients treated using ECMO in 2009 at our hospital were under 18 years of age. Limited nurse experience with ECMO and resultant nursing staff nervousness / pressure when using this technique encouraged us to establish an ad hoc group to explore ECMO care and related issues.Purpose: Improvement measures were implemented to (1) raise the pre- ECMO placement integrity of order sheets to 98%; (2) reduce materials preparation time to below 60 minutes; and (3) enhance nursing care ECMO cognitive accuracyto 99%.Resolution: We implemented the following intervention measures: (1) A dedicated ECMO vehicle was deployed to enhance clinical work convenience and safety; (2) a ECMO technique preparation checklist was developed to improve tubing placement and reduce preparation time; (3) an ECMO care in-service education program was developed to enhance nurses' ECMO care awareness and skills; (4) an ECMO trainee system was established to increase nurses ECMO care experience and reduce negligence-related errors.Results: Project results included: material preparation order sheet accuracy rose from 25% to 100%; average materials preparation time fell from 90 to 40 minutes, and nursing staff ECMO cognitive accuracy increased from 51.2% to 99.2%. The program achieved all stated objectives.Conclusions: This program enhanced the quality of ECMO care for pediatric patients, reduced materials preparation times, and improved the nursing approach to ECMO care.