提升心臟加護病房護理人員執行連續性腎臟替代治療認知及操作能力之改善專案

A Project for Improving the Nurses' Knowledge and ability to Operate Continuous Renal Replacement Therapy in Cardiac Intensive Care Unit

本專案目的在提昇護理人員對連續性腎臟替代治療認知及操作能力。經調查發現，因無制訂CRRT照護標準作業且未舉辦專科在職教育課程，缺乏警告排除手冊和儀器操作光碟教學教材，護理人員對此項技術認知及操作能力正確率分別僅有51.2％及31.5％，護理人員備物平均約10分，從連續性腎臟替代治療預充到儀器接置病人身上平均約2小時，排除警訊平均5－10分鐘。自2016年11月1日至2017年4月30日，參考文獻擬定改善包括：（1）製作CRRT多媒體教學光碟；（2）CRRT儀器操作模組練習；（3）舉辦CRRT在職教育課程；（4）制訂CRRT照護標準作業。透過專案實施後，結果顯示：護理人員對此項技術認知由51.2％提升98.6％，操作能力31.5％提升98.1％，備物平均時間由10分鐘縮減至8分鐘，執行連續性腎臟替代治療預充到儀器接置病人身上使用由120分鐘減少至60分鐘，排除警訊及解決問題時間也由5－10分鐘下降至2分鐘，顯示專案介入措施成效顯著。

The purpose of this project was to improve nurses' knowledge and ability to operate continuous renal replacement therapy (CRRT) in the cardiac intensive care unit. According to our investigation, the proportion of nurses who had full knowledge about CRRT and could correctly execute the whole procedure were 51.2% and 31.5%, respectively, before we launched this project. The average time for material preparation was 10 minutes, for completing the setting (from mechanical preparation to preform therapy on patients) was 2 hours, and for dealing with trouble-shooting was 5-10 minutes. The data indicated that nurses still lacked sufficient knowledge and skills on performing CRRT. This project was launched from November 1, 2016, to April 30, 2017. By reviewing other studies to improve our downsides, we confirmed several interventions were necessary, including recording a video for demonstration, arranging lessons of clinical skills of CRRT, practicing with demo materials after classes, and to building up a standard protocol for preforming CRRT. After this project, some substantial improvements were observed such as the proportion of nurses' knowledge on CRRT had increased from 51.2% to 98.6%, the average preparation time had decreased from 10 to 8 minutes, the average time of completing the setting had decreased from 120 to 60 minutes, the average time of dealing with troubleshooting had decreased from 5-10 minutes to 2 minutes, and the accuracy of performing CRRT had significantly increased from 31.5% to 98.1%. The result indicated that our project has an effective and remarkable outcome.