運用跨團隊整合照護降低冠狀動脈繞道手術後傷口感染率

Multidisciplinary Collaboration to Reduce Wound Infection Rate Following Coronary Artery Bypass Grafting

本專案旨在運用跨團隊整合照護以降低冠狀動脈繞道術後之傷口感染率，避免延長住院天數、增加病人再入院與死亡率。本單位於2016年第一季冠狀動脈繞道術後傷口感染率高達6.56％，高於科部閥值3.8％，故引發專案小組改善動機。本專案經現況分析後發現導因為護理師手術前皮膚清潔範圍不一致、預防性抗生素劑量未依病患體重調整、醫師醫囑術後傷口換藥方式不一致、醫師與護理師對於術後血糖控制理想範圍觀念不清等。透過跨團隊合作修訂手術部位皮膚準備流程、製作術前皮膚準備流程卡、建立個別化體重預防性抗生素與防呆式血糖控制套餐醫囑、建立一致性傷口換藥方式與流程等措施，有效降低冠狀動脈繞道術後傷口感染率至3.36％，達專案目標並提升病人手術醫療品質。

This project aims to reduce the length of stays in the hospital, readmission rates, and patients' mortality by providing multidisciplinary care to prevent surgical site infection following coronary artery bypass grafting (CABG). The incidence of postoperative infections in the surgical cardiac unit was 6.56% in the first season of 2016, higher than the standard 3.8% of the surgical department. The project team identified several potential causes: the quality of nurse-performed preoperative skin preparation was inconsistent; the dosage of prophylactic antibiotics was not adjusted based on the patient's weight; the order for the surgical wound dressing varied between doctors; the members among the care team had different understandings to optimal glucose control. By standardizing the protocol and created a checklist for preoperative skin preparation, establishing orders package with an individualized dosage of prophylaxis antibiotics and a personalized plan of glucose control, and standardizing postoperative wound dressing, the project effectively improved the quality of care and reduced the wound infection rate following CABG to 3.36% through the multidisciplinary collaboration.