建構護理資訊系統改善電腦斷層定位合併顯影劑施打完整率專案

Establishing a Nursing Informatics System to Improve the Completion Rate of Computed Tomography Simulation With Contrast Injection

背景：電腦斷層定位合併顯影劑施打過程，因醫療人員執行過程步驟不一致與遺漏，顯影劑滲漏及副作用處置能力不足，且無訂定顯影劑施打流程的規範使臨床醫療人員可遵守，進而可能影響病人定位過程的安全與品質，故引發專案小組改善動機。現況分析確立顯影劑施打完整率低的主因為：缺乏顯影劑施打的標準作業資訊系統、缺乏專屬的氧氣及抽痰設備、無顯影劑放入溫箱的規範、護理師未覆核病人顯影劑過敏史、未落實靜脈留置針施打規範、接受電話口頭顯影劑醫囑、未落實病人辨識及對顯影劑施打的評估與認知不足。目的：電腦斷層定位合併顯影劑施打完整率由65％提升至95％。解決方案：自2016年4月1日至2016年12月31日止，執行改善策略包括：（1）護理引導跨科部合作建置顯影劑施打標準作業之護理資訊系統；（2）建立及落實病人辨識的標準做法；（3）靜脈留置針施打與顯影劑放入溫箱的規範；（4）建置專屬的氧氣及抽痰設備；（5）教育課程及顯影劑施打的操作訓練。結果：電腦斷層定位合併顯影劑施打過程的各層面的完整率由65％提升至95％。結論：期望藉此專案分享團隊合作改善電腦斷層定位合併顯影劑施打的完整率及提升病人安全的照護品質。 Background & Problems: Problems that influence the safety and quality of the patient-positioning process during computed tomography (CT) simulation with contrast injection include: 1) inconsistent and incomplete procedures performed by medical staffs, 2) poor prevention of developer leakage and handling of side-effects, and 3) the lack of a standardized protocol. Desire to improve this situation encouraged us to do this project. Adverse events during CT simulation with contrast injection procedures are largely attributable to the lack of a standardized nursing informatics system, with other causes including nurses incorrectly performing allergy history assessments, incorrect communications with the doctor due to verbal orders given by phone, failure to perform proper patient identification and intravenous catheterization procedures, lack of assessment and knowledge about contrasts, lack of guidelines for warming contrast in the incubator, and lack of oxygen and sputum suction equipment. Purpose: To improve the rate of completion of CT simulation with contrast injection procedures from 65% to 95%. Resolution: This project was conducted between April 2016 and December 2016. Our strategy included establishing a nursing informatics system for the CT simulation with contrast injection process. This system included a standard patient-identification procedure, protocol for the correct placement of intravenous needles, standard specifications for the using an incubator with contrast, installation of oxygen and sputum suction equipment, and implementation of a nursing education and training program. Result: This project with associated strategies improved CT simulation with contrast injection completion rates in all domains from the original 65% to 95% at the end of the project period. Conclusions: This project improved significantly the completion rates of the CT simulation with contrast injection process. We want to share this experience to help other hospitals and to improve patient safety and quality of care.