運用多元教學策略提升血液腫瘤護理師對急性輸血反應之緊急處理能力改善專案

Applying Multi-teaching Strategies to Improve the Recognition of Acute Transfusion Reactions and Emergency Management Ability of Hematology Nurses

目的：發生率高且變化快速的急性輸血反應使護理師倍感壓力，期望藉此專案提升護理師急性輸血反應認知及緊急處理能力。方法：經「急性輸血反應認知問卷」調查、輸血護理作業規範查核及檢視「急性輸血反應緊急應變流程」，分析現況發現真因為：一、單位缺乏在職教育；二、未建立「急性輸血反應緊急處理」標準教案、評核表及訓練計畫；三、缺乏有效醫護溝通；四、輸血護理作業規範遵從率低且缺乏查核機制；五、緊急應變流程簡要。2018年3月至9月運用多元教學策略進行專案改善，設計「常見輸血反應與臨床處置」影片進行翻轉教室學習；舉辦在職教育加強「ISBAR醫護溝通技巧」、宣導「輸血反應-停、看、聽、報、報」教學標語、提醒醫師開立輸血反應調查及輸血護理規範宣導；製作OSCE教案完成護理師技能訓練；建立輸血反應緊急應變流程及規範查核機制。結果：「急性輸血反應認知正確率」由30.4％上升至90.6％；「急性輸血反應緊急處理能力教案正確完成率」達88.5％；「輸血護理作業規範遵從率」由61.9％上升至93.1％。結論：本專案透過多元教學策略，有效提升護理師急性輸血反應認知正確率及緊急處理能力，期能藉此專案成效提供其它同質性病房之參考。（澄清醫護管理雜誌2020；16（3）：65-76）

Purposes: The high incidence and rapid change of acute transfusion reactions make nurses feel pressured. The purpose of this study is that it may be used to improve nurses' recognition of acute transfusion reactions and emergency management ability. Methods: Analysis of the acute transfusion reaction cognitive questionnaire, blood transfusion nursing standards, and the emergency response procedures for acute transfusion reactions suggested that (1) inadequate in-service education was provided to our unit; (2) standard teaching plans, assessment forms, and training programs for the emergency management of acute transfusion reactions were not available; (3) there was insufficient effective communication between doctors and nurses; (4) the compliance rate of blood transfusion nursing standards was low, and additionally, an examination program was absent; and (5) the existing emergency response procedures were excessively brief. Therefore, multi-teaching strategies were implemented between March and September 2018 to improve the recognition of acute transfusion reactions and the emergency management ability of hematology nurses. These strategies included introducing flipped classrooms using the ''common blood transfusion reactions and their clinical managements'' video, providing in-service education to strengthen ISBAR communication skills between doctors and nurses, promoting the ''transfusion reaction: stop, look, listen, report, and record'' concept, reminding doctors to perform investigations on blood transfusion reactions and advocating nursing standards for blood transfusion, conducting nursing skills training through OSCE teaching plans, and establishing emergency response procedures for transfusion reactions as well as standardizing examination programs. Results: Implementation resulted in the correct recognition rate of acute transfusion reactions increasing from 30.4% to 90.6%, the correct completion rate of the teaching plan for acute transfusion response emergency procedures increasing to 88.5%, and the compliance rate of blood transfusion nursing standards escalating from 61.9% to 93.1%. Conclusions:Through multi-teaching strategies, the nurses’ recognition rate of acute blood transfusion reactions as well as their emergency management abilities effectively improved; thereby providing references for other wards with similar demands. (Cheng Ching Medical Journal 2020; 16(3): 65-76)