提升心臟加護護理人員執行生理監視器參數設定之正確率

Improving the Accuracy of Monitor Settings in a Cardiac ICU

本專案旨在提升心臟加護護理人員執行生理監視器參數設定之正確率。專案執行前護理人員執行參數設定正確率僅20.3％，分析原因：護理人員參數設定認知61.7％、未依規範設定警訊上下限值、未設置簡易床邊操作手冊及操作介面複雜、病房常規無參數設定指引及未定期舉辦教育訓練。團隊擬訂下列解決策略：修訂生理監視器參數設定的操作流程、設計生理監視器專科模組（arrhythmia模組與ischemia模組）、錄製操作步驟的影片、定期舉辦教育訓練及制定稽核制度。在團隊努力下，生理監視器參數設定正確率二次評值由20.3％提升92.2％及94.8％、認知61.7％提升至91.5％達成目標。本專案推行後，不僅提供心臟加護病房護理人員能及早監控病人的變化，更能運用相同架構的解決方案推展至各重症加護單位，建構專科屬性的監控項目，以提升病人之安全與照護品質。

The aim of this project was to improve the accuracy of monitor settings in cardiac intensive care units (ICUs). The accuracy of monitor settings in this project was only 20.3%, and the identified reasons were as follows: the knowledge of nursing staff regarding the monitoring system was only 61.7%, the system was not setting correctly according to the alarm, the lack of bedside operation manuals, a complex operational interface, a nonstandard ward routine, and a lack of timely educational training. Our team developed the following strategies based on the analysis of the current situation: (1) Standardizing the operating and setting sequence of monitors, (2) setting the modules for cardiological parameters such as arrhythmia and ischemia, (3) making educational videos for monitor setting, and (4) periodic training and evaluation. The accuracy of monitor settings in a cardiac ICU improved from 20.3% to 92.2% immediately and to 94.8% by the third week due to the efforts of our team. The knowledge of nursing staff regarding the monitoring system also improved from 61.7% to 91.5%. The project significantly improved the technique of monitor setting in a cardiac ICU; this improvement can help medical teams swiftly handle changes in a patient's condition. The same strategies can be applied in other ICUs to build different parameter modules for varied specialties and to improve the quality of care for critically ill patients.