提昇輸送型嬰兒處理台使用正確率之改善方案

Quality Improvement Project: Increasing the Rate of Proper Use of Infant Transferring Warmers

背景：輸送型嬰兒處理台可提供高危險性新生兒保暖及緊急照護如呼吸器裝置，正確使用可以減少新生兒合併症並提昇存活率。專案小組發現護理師使用輸送型嬰兒處理台時，經常抱怨機器無法運作，但檢測結果卻正常。為了解原因，進一步查核護理師對處理台使用正確率僅68.4%。分析原因為，於護理師方面：認知不足及資淺護理師多；制度方面：未制定標準作業程序、稽核制度及教育訓練不足；設備方面：無備物標準及呼吸器管路不易組裝。目的：改善後護理師的輸送型嬰兒處理台使用正確率由68.4%提昇至100%。解決方案　藉由實施在職教育、制定處理台標準作業程序、製作處理台操作流程之光碟及海報、簡化備物內容並定期執行稽核。結果　護理師使用的輸送型嬰兒處理台使用正確率達100%，另外護理師使用處理台之滿意度亦由51.4%提高至80.6%。結論　實施改善方案後，能有效提昇護理師正確使用輸送型處理台及提昇護理照護品質。

Background & Problems: Infant-transferring warmers provide a warm environment and emergency care facilities such ventilators for high-risk infants during transport. Accurate use of this warmer has been demonstrated to reduce rates of neonatal complications and increase rates of survival. This project found that, despite the complaints of nurses that warmers occasionally malfunctioned during the transfer process, warmer functions nearly always tested normal after use. Therefore, the researchers surveyed ward nurses to better understand the underlying reasons for these complaints. Results found that only 68.4% of those surveyed operated the warmer correctly. The reasons for improper use were analyzed and categorized as: Nurse-related factors- lack of warmer operating knowledge and experience in the clinic; System-related factors-lack of a standard operating procedure (SOP) and monitor/audit practices and an incomplete training protocol; Equipment-related factors - lack of an equipment preparation SOP and difficulties in setting the ventilator properly. Purposes: The purpose of this project was to achieve a 100% rate of proper warmer use among nurses. Resolution: Through continuous clinical education, we created a standard operating procedure for warmer operation, created a video and poster for warmer users, simplified the equipment preparation SOP, and periodically monitored and checked results. Results: After the intervention, 100% of the nurses were able to use the warmers correctly. Additionally, the rate of satisfaction for nursing-warmer use among the participating nurses increased from 51.4% to 80.6%. Conclusion: This project effectively increased the rate for correctly using transferring warmers among participating nurses and improved the quality of medical care.