提升主要照顧者執行居家全靜脈營養照護之正確率

Improving the Accuracy of Caregiver-Provided In-Home Total Parenteral Nutrition Care

背景：調查本科2011年9月至12月出院前主要照顧者執行居家全靜脈營養照護正確率偏低僅62.0%，護理人員執行護理指導執行率僅22.2%；經現況分析發現主要問題為：缺乏標準作業流程、護理指導不一致、衛教工具不易瞭解及主要照顧者無法有效學習成效所致。目的：（1）提升主要照顧者執行居家TPN（total parenteral nutrition）照護正確率達90%；（2）提升護理人員執行居家TPN護理臨床指導之執行率達90%。解決方案：經問題確立及參考文獻後，設立改善策略，包括（1）制定護理臨床指導路徑；（2）跨團隊與TPN小組共同製作衛教光碟；（3）設計回覆示教模型包提供反覆練習；（4）定期舉辦團體衛教。結果：主要照顧者於出院前執行居家全靜脈營養照護正確率可達100%，且護理人員指導執行居家全靜脈營養照護之執行率達100%。結論：藉由制定護理臨床指導路徑，透過回覆示教模型包操作，可提升主要照顧者執行居家全靜脈營養照護正確率，增加其自信心。本專案最大的效益是已由護理部TPN小組，於院內平行推展至相關單位執行，並落實於日常管理。

Background & Problems: According to current surveys conducted between September and December 2011, the accuracy of primary caregiver-administered Home Total Parenteral Nutrition Care (HTPNC) was 62.0%. Further, nursing staffs provide instruction on HTPNC to only 22.2% of caregivers responsible for administering HTPNC. Main related causes were: (1) difficult to comprehend health education tools; (2) inconsistent nursing guidelines; (3) a lack of relevant standard operating procedures; and (4) poor caregiver adoption of TPN skills.Purposes: This project was developed to (1) increase the accuracy of primary caregiver-administered HTPNC to 90% and (2) increase the percentage of nurse-administered HTPNC to 90%.Resolutions: We developed appropriate nursing guidelines, created a health education CD-ROM with input from a cross-disciplinary team and total parenteral nutrition focus group, designed reusable teaching model aids for repetitive practice, and held regular group health education sessions.Results: The nursing staff HTPNC instruction rate increased to 100%. Caregiver HTPNC implementation accuracy increased to 100% prior to patient discharge.Conclusions: This approach was successful in achieving its stated goals. Further, using reusable teaching model aids may reduce caregiver anxiety and increase caregiver confidence. The greatest benefit of this project was its extension of teaching model aids to relevant units, allowing for routine monitoring by the department of nursing quality management.