運用醫療團隊資源管理提升新生兒加護病房醫療人員執行呼吸器相關性肺炎預防措施正確性

Using TRM to Enhance the Accuracy of Ventilator-Associated Pneumonia Preventive Measures Implemented by Neonatal Intensive Care Unit Medical Staffs

背景：呼吸器相關性肺炎（ventilator-associated pneumonia, VAP）為新生兒加護病房常見的醫療照護相關感染之一，本加護單位2015年6月至8月VAP之平均感染密度為4.7‰，引發專案小組改善動機。藉由現況調查發現臨床在職教育缺乏專科性導致醫療人員對預防新生兒VAP照護認知不足，且無相關照護指引，以致提供新生兒VAP的預防措施不一致。目的：提升醫療人員VAP預防措施正確性，並降低新生兒加護病房內VAP感染密度。解決方案：經文獻檢索並導入醫療團隊資源管理，建立團隊有效溝通、監測機制以及獎勵措施，制定專科性在職教育內容及專屬的照護指引，使醫療人員照護有所依據，增設設備輔助及提醒使預防措施能落實執行。結果：醫療人員執行VAP預防措施正確性由70.1%提升至97.9%，新生兒加護病房之VAP感染密度由4.7‰降至0.52‰。結論：透過醫療團隊整合，提升醫療人員執行VAP預防措施正確性，成功地降低VAP感染密度，使新生兒獲得更具品質的專科照護。

Background & Problems: Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in the neonatal intensive care unit (NICU). The average VAP infection density was 4.7‰ in our unit between June and August 2015. The results of a status survey indicated that in-service education lacked specialization, leading to inadequate awareness among staffs regarding the proper care of newborns with VAP and a lack of related care guides. This, in turn, resulted in inconsistencies in care measures for newborns with VAP. Purpose: To improve the accuracy of implementation of preventive measures for VAP among medical staffs and reduce the density of VAP infections in the NICU. Resolutions: Conduct a literature search and adopt medical team resources management methods; establish effective team communication; establish monitoring mechanisms and incentives; establish mandatory in-service specialization education contents and a VAP preventive care guide exclusively for newborns as a reference for medical staffs during care execution; install additional equipment and aids and set reminders to ensure the implementation of VAP preventive measures. Results: The accuracy rate of preventive measure execution by medical staffs improved from 70.1% to 97.9% and the VAP infection density in the NICU decreased from 4.7‰ to 0.52‰. Conclusions: Team integration effectively improved the accuracy of implementation of VAP-prevention measures, reduced the density of VAP infections, enhanced quality of care, and ensured that newborns received care that was more in line with specialization needs.