護理人員使用密閉給藥裝置執行化療給藥之感受

Nurses' Perception to a Closed Transfer Device for Chemotherapy Administration

執行靜脈滴注化療藥品給藥流程若使用密閉給藥裝置（closed system transfer devices, CSTD），可降低護理人員自身之暴露化療藥品危害和降低工作環境污染。研究目的為探討護理人員對於使用密閉給藥裝置與原流程（即藥師完成輸液套管排氣並調配完成之化療藥品）執行化療給藥之感受差異，以及影響護理人員對於使用密閉給藥裝置執行化療給藥感受的相關因素。本研究採橫斷式研究設計，以臺灣北部某醫學中心19個單位之護理人員為研究對象。由研究者自行發展結構式問卷收集資料，問卷內容包括四個部分，分別為：使用效能感受、暴露化療藥品感受、CSTD操作感受與個人特性。共收集242份有效問卷，結果顯示護理人員對使用CSTD執行化療給藥之使用效能感受顯著高於原流程（t＝4.0，p＜0.001）；而對暴露化療藥品感受顯著低於原流程（t＝-8.04，p＜0.001）。護理人員每天執行化療給藥筆數會影響其對於使用CSTD的效能感受、暴露化療藥品感受、CSTD操作感受。護理人員若有參加面授課程或網路數位課程，其使用CSTD之操作感受程度較高。護理人員以兩種學習管道學習使用CSTD，其對CSTD操作感受高於僅由一種學習管道者。建議未來醫療機構管理者在導入新醫療設備或流程時，可深入了解頻繁操作特定工作流程之使用者觀點。此外，提供使用者操作說明與多元教育訓練管道，讓使用者安排自我學習的時間，以提升其對於使用新醫療設備或流程感受，進而順利導入提升病人安全與員工安全之新醫療設備與流程。

Implementation of Closed System Transfer Devices (CSTD) in chemotherapy intravenous administration procedures can diminish nurse providers' exposure risk and contamination of the workplace by chemotherapy. The aim of this study was to compare the implementation of CSTDs devices to traditional devices with regard to nurses' perceptions, including chemotherapy administration of operating procedures and associated factors. This study was a cross-sectional survey of nurses selected at 19 nursing units in one medical center in northern Taiwan. Data were collected by structured questionnaires designed by the investigators, including four parts: efficacy of the use of CSTD, exposure to chemotherapy, CSTD use procedures, and demographic information for nurses. A total of 242 nurses completed the questionnaires. The findings showed that the efficacy of the use of CSTD was better than the prior processes (before the implementation of CSTD, t=4.0, p < 0.001), and the perceptions of exposure to chemotherapy were less than those before CSTD had been implemented (t=-8.04, p < 0.001). The number of doses that nurses performed chemotherapy each day affected their efficacy, exposure to chemotherapy, and CSTD use procedures. Nurses who learned about the use of CSTD from face-to-face or web-based continuing learning classes may have increased the level of positive perception for CSTD use procedures. Nurses who used two learning resources had more positive perceptions than nurses who used only one learning resource. We suggested that when medical institutions are considering implementing new devices or procedures, they should understand the opinions of the nurses who will frequently manage specific procedures. In addition, providing users with handling instructions and multifaceted learning resources and allowing them to arrange self-learning time independently can improve their perceptions about new devices or procedures and their implementation, which can successfully increase patient safety as well as occupational safety.