提升重症護理師對連續性血液透析照護能力之改善專案

Improve the Ability of Nurses to Implement Continuous Veno-Venous Hemodialysis

背景：重症病人常因血液動力學不穩定且使用高劑量升壓藥物之下需進行連續性血液透析，然而本單位護理師常無法即時正確安裝透析儀器，可能影響病人腎臟功能恢復的機會及存活率。經調查確認原因為人員缺乏操作練習、僅有口頭教學、無足夠在職教育及對裝機所需用物不熟悉等，故引發專案小組改善動機。目的：護理師連續性血液透析照護認知與操作之正確率皆提升至90%以上。解決方案：採用多元且有效的策略如提供數位教材與教學隨身手冊、規劃實機操作和臨床情境模擬、舉辦系列課程及臨床案例討論、修改新進人員訓練辦法並制訂用物準備檢核表和用物專區等提升照護能力。結果：護理師連續性血液透析照護認知正確率由55.2%提升至90.8%；操作正確率61.9%進步到90.5%。結論：運用多元教學策略模式，可有效提升重症護理師困難護理技術之能力，提供更安全且高品質之重症照護服務。

Background & Problem: Many critically ill patients require continuous veno-venous hemodialysis （CVVH） due to their hemodynamic instability and high-dose inotropic use. However, our surgical intensive care unit nursing staffs are often unable to set up the dialysis circuit in a correct and timely manner, which necessitates requesting the assistance of nearby units. After detailed investigation and analysis, this problem is attributable to the lack of nursing staff handson practice, an over reliance on oral instructions, the insufficiency of in-service education, and a lack of familiarity with CVVH set-up equipment. Purpose: This project was designed to augment the comprehension and accuracy rates of clinical CVVH practice among nursing staff to > 90%. Resolutions: In order to help our nursing staffs master the skills necessary to manage the CVVH device, we employed versatile and effective strategies that included providing electronic teaching materials and instruction handbooks as well as practical hands-on sessions and clinical scenario simulations. Moreover, we conducted serial core courses and held case conferences that focused on the topic of CVVH nursing care. Furthermore, training programs for new members were devised, the standard CVVH device checklist was modified, and a specialized preparation area was delineated in hopes of improve nursing-care standards. Results: Under these schemes, the rate of comprehension of CVVH among nursing staffs increased from 55.2% to 90.8% and the accuracy rate of clinical practice increased from 61.9% to 90.5%. Conclusion: Our implementation of various effective strategies not only promoted the CVVH management ability of nursing staffs but also provided quality care to critically ill patients.