降低外籍看護執行管路照護錯誤率之改善專案

A Project to Reduce the Incidence of Intubation Care Errors among Foreign Health Aides

背景：台灣老人及身障人口多仰賴外籍看護為主要照顧者，良好照護技能能提升病人安全。本單位於2010年外籍看護鼻胃管照護錯誤率達58%、氣切管照護錯誤率達57%。經訪談外籍看護及進行護理人員問卷調查，發現錯誤率高的主因有：語言溝通困難、缺乏適當的衛教指導工具及外籍看護管路衛教標準。目的：外籍看護執行鼻胃管管路照護錯誤率經由專案之執行後由58%降為20%，氣切管路照護錯誤率由57%降為20%。解決方案：專案小組以製作印尼文管路照護衛教單張、設立以印尼文標示的衛教單張櫃、製作印尼文管路照護衛教海報、拍攝印尼文管路照護衛教影片及製定外籍看護管路衛教標準等方法，為解決方案。結果：2011年12月15日至12月31日共評核外籍看護執行鼻胃管照護者21人，執行氣切管照護者11人，照護對象同時具2種管路者則分別評核計算。外籍看護執行管路照護錯誤率鼻胃管由58%降低至18%，氣切管由57%降低至18%。結論：經專案實施後降低外籍看護執行管路照護錯誤率，提升外籍看護管路照護技能，使病人獲得質優照護。

Background & Problems: Foreign health aides are the main providers of care for the elderly and the physically disabled in Taiwan. Correct care skills improve patient safety. In 2010, the incidence of mistakes among foreign health aides in our hospital unit was 58% for nasogastric tube care and 57% for tracheostomy tube care. A survey of foreign health aides and nurses in the unit identified the main causes of these mistakes as: communication difficulties, inaccurate instructions given to patients, and a lack of standard operating procedures given to the foreign health aides. Purposes: This project was designed to reduce the rates of improper nasogastric tube care and improper tracheostomy tube care to 20%, respectively. Methods: This project implemented several appropriate measures. We produced patient instruction hand-outs in Bahasa Indonesia, established a dedicated file holder for Bahasa Indonesian tube care reference information, produced Bahasa Indonesian tube-care-related posters, produced a short film about tube care in Bahasa Indonesian, and established a standardized operating procedure for tube care in our unit. Results: Between December 15^th and 31^st, 2011, we audited the performance of a total of 32 foreign health aides for proper execution of nasogastric tube care (21 aides) and of proper execution of tracheostomy tube care (11 aides). Patients with concurrent nasogastric and tracheostomy tubes were inspected separately for each care group. The incidence of improper care decreased from 58% to 18% nasogastric intubation and 57% to 18% for tracheostomy intubation. Conclusion: This project decreased significantly the incidence of improper tube care by the foreign health aides in our unit. Furthermore, the foreign health aides improved their tube nursing care skills. Therefore, this project improved the quality of patient care.