運用突破性手法提升外科加護病房中心靜脈導管照護之專案

Using Groundbreaking Methods to Improve Central Venous Catheter Nursing in Surgical Intensive Care Units

中心靜脈導管的照護不僅影響病人的治療同時也影響病人的住院品質，故第一線醫護人員必須具備知識和技術能力，避免病人在接受治療的過程中受到傷害。本專案旨在提升外科加護病房中心靜脈導管照護，專案期間自2014年2月1日至2014年10月15日，經現況分析發現確認中心靜脈導管相關血流感染率偏高6.4‰之問題，其原因為：放置中心靜脈導管流程正確率為84.5%、護理人員中心靜脈導管照護正確率為88%、缺乏執行放置中心靜脈導管流程及照護稽核方法、缺乏備物便利性設備。 Careful insertion and maintenance of a central venous catheter (CVC) affect patient treatment and the quality of their hospitalization. It is therefore necessary for frontline medical employees to have the requisite professional knowledge and skills to avoid harming patients during treatment. The purpose of this project was to improve the completeness of CVC nursing. The project took place from February 1 to October 15, 2014. After analysis, results indicated that the CVC-related blood infection rate was slightly higher than 6.4‰. Infection causes were the accuracy of CVC placement (84.5%), the accuracy of CVC nursing (88%), the failure to evaluate CVC placement, and the lack of facilities. We thus proposed interventions to correct these deficiencies, namely holding nursing training courses, developing CVC placement and nursing standard operating procedures (SOPs), making an educational training DVD detailing SOPs, designing CVC nursing evaluation forms, producing CVC removal and adjustment instruction forms, and establishing a CVC trace team. Additionally, we propose that medical facility carts with CVC placement equipment should be prepared as well as the auxiliary frame. Through these interventions, which entail a series of improvement policies and deployment of an appropriately trained nursing staff, we aim to lower the incidence of CVC bloodstream infections and ensure patient safety.