提升經皮週邊靜脈導管照護正確性－－以客觀結構式臨床測試為例

Improving the Care Accuracy of Percutaneously Inserted Central Catheters Using Objective Structured Clinical Examination

台灣每年約有9,800件管路異常通報事件，大多數重症新生兒或早產兒使用經皮週邊靜脈導管（percutaneously inserted central catheters, PICCs）提供水份、營養與重要輸液。客觀結構式臨床測試（objective structured clinical examination, OSCE）是一種客觀評量醫療專業人員臨床能力的方式，台灣目前少有研究探討OSCE對改善臨床護理人員於PICCs的照護正確性，以降低非預期性拔管率。本文旨在新生兒中重度病房介入PICCs照護教案與教具，及標準化臨床教師指導內容，並結合OSCE，以改善臨床護理人員因對PICC專業知識及照護經驗不足，而造成非預期拔管率，進而提升PICCs照護品質。專案執行期間自2013年2月20日至2013年10月30日止，結果顯示護理人員對PICCs照護認知由87%提升至91.5%，且PICCs技能正確性由59.1%提升至97.3%，非預期拔管率由63.6%下降至16.7%。因此，OSCE方式確實使PICCs照護品質得到提升，且即時回饋更能讓測試者與受試者同時得到學習與成長。

Approximately 9,800 adverse events related to medical tubing are reported in Taiwan every year. Most neonates in critical condition and premature infants acquire fluid, nutrition, and infusion solution using percutaneously inserted central catheters (PICCs). Objective structured clinical examination (OSCE) is an objective evaluative tool that may be used to measure the clinical competence of healthcare professionals. Very little is known about the effects of OSCE in Taiwan in terms of improving the accuracy of use of PICCs in nursing care and of reducing unexpected medical tubing removals. The present project aimed to explore the effects of an OSCE course on these two issues in the realms of standard operating procedures, care protocols, and training equipment at a neonatal intermediate unit in Taiwan. The duration of the present study ran from 2/20/2013 to 10/30/2013. The results showed that nurses’ knowledge of PICCs improved from 87% to 91.5%; nurses’ skill-care accuracy related to PICCs improved from 59.1% to 97.3%; and incidents of unexpected tube removals declined from 63.6% to 16.7%. This project demonstrated that OSCE courses improve the quality of PICC nursing care. Additionally, the instant feedback mechanism within the OSCE course benefited both teachers and students