降低某內科病房膽道引流管滑脫率之專案

A Proposal to Reduce Biliary Track Drainage Catheter Slippage Rate in the Medical Ward

病患常因膽道炎症阻塞需放置膽道引流管，若不及時置入易造成敗血性休克而危及生命，引流管的放置與照護對疾病復原是相當重要的，單位病人常置放膽道引流管，近期發現膽道引流管滑脫件數偏高，導管滑脫不僅造成病人身體的危害，也讓治療的時間延長，故成立專案小組，探討導因包括引流管固定方法不適當、引流管敷料選擇性多樣、引流管懸垂易拉扯、缺乏統一引流管固定標準流程、缺乏稽核制度。確立問題擬訂計劃後，進行對策措施改善，包括簡化引流管固定流程、統一引流管固定敷料、落實使用別針將引流管固定於上衣下擺、重新修訂引流管固定照護標準流程、定期查核人員執行引流管照護的成效。引流管滑脫率改善措施有助運用於臨床照護，讓醫護人員提供照護管路時，能更加謹慎預防滑脫，減少病人傷害，提高照護品質。專案改善後評值引流管滑脫率由3.6%下降至0.5%，達到本專案目標。 Patients with an obstructed or an infected biliary tract are easily susceptible to biliary disease. This condition must be treated timely using a catheter to avoid life-threatening complications. Such treatment can help the patient to maintain smooth flow of the bile, there avoid septic shock that endangers the health and safety of the patient. Therefore, the catheter must be placed in the biliary tract on time for treating this disease. Recently, we have been observing a high slippage rate of biliary tract drainage catheter In our ward, which not only endangers the safety of the patient's health but also prolongs the treatment time. Therefore, a team was formed to improve this condition, which identified the following problems: that needs improvement in the fixing methods, differences existed in drainage catheter, the drainage catheter could be pulled out easily, there was a lack of a standard process for uniform fixing of the drainage catheter, and there was a lack of an audit system. When the team had analyzed and established the problem, few measures were proposed, which included simplifying the drainage catheter fixation procedure, unifying the drainage catheter fixation dressing, implementing the use of pins to fix the pipeline, revising the drainage catheter care procedure, and checking the implementation of the pipeline care effectiveness regularly. After implementing these administrative protocols, the drainage catheter slippage rate decreased from 3.6% to 0.5%, the purpose of this project has been achieved.

Patients with an obstructed or an infected biliary tract are easily susceptible to biliary disease. This condition must be treated timely using a catheter to avoid life-threatening complications. Such treatment can help the patient to maintain smooth flow of the bile, there avoid septic shock that endangers the health and safety of the patient. Therefore, the catheter must be placed in the biliary tract on time for treating this disease. Recently, we have been observing a high slippage rate of biliary tract drainage catheter In our ward, which not only endangers the safety of the patient's health but also prolongs the treatment time. Therefore, a team was formed to improve this condition, which identified the following problems: that needs improvement in the fixing methods, differences existed in drainage catheter, the drainage catheter could be pulled out easily, there was a lack of a standard process for uniform fixing of the drainage catheter, and there was a lack of an audit system. When the team had analyzed and established the problem, few measures were proposed, which included simplifying the drainage catheter fixation procedure, unifying the drainage catheter fixation dressing, implementing the use of pins to fix the pipeline, revising the drainage catheter care procedure, and checking the implementation of the pipeline care effectiveness regularly. After implementing these administrative protocols, the drainage catheter slippage rate decreased from 3.6% to 0.5%, the purpose of this project has been achieved.