提升神經外科術後護理完整性之專案

A Project to Improve Post-operative Care Completion Rate in a Neurosurgery Ward

神經外科病人術後照護需預防中樞神經感染，若因傷口或管路照護不當引發感染及敗血症等合併症，而管路引流量過多容易導致病情嚴重變化，間接延長住院天數及增加醫療成本，因管路引流過量增加病人住院天數引發專案動機。本專案旨在提升病房執行神經外科術後護理之完整率，以觀察法及質性訪談發現護理師執行神經外科術後護理完整率為73.3％，分析原因為無相關教育訓練、術後護理認知不足、衛教內容不一致、缺乏衛教單張及流程圖。故舉辦在職教育及床邊擬真教學、制定常見術式之衛教單張及衛教內容確認單、內部品管稽核術後指導正確性及制定術後作業照護標準及臨床路徑。改善後術後護理完整率提升至95％、護理師術後護理認知正確率提升為89.1％，達成專案目的。此專案能有效提升神經外科術後護理完整率及預防術後感染合併症發生。

Postoperative care for neurosurgical patients is important for preventing central nervous system infection. Wounds, drainage infections, or even sepsis could lead to additional patient injuries, prolonged length of hospital stay, and increased medical costs. Excessive amount of drainage could negatively impact the prognosis. This project aimed to improve the completion rate of postoperative care in the neurosurgery ward. Observation and qualitative interviews were used to evaluate the completeness of postoperative care among nurses and revealed that the completion rates was 73.3%. The following problems were identified: insufficient knowledge neurosurgery postoperative care among nurses, insufficient and inconsistent teaching materials, and a lack of standardized protocols and flow charts. Strategies for this project included continuing education, conducting bedside situated teaching, developing surgical teaching leaflets and health education materials, establishing an evaluation mechanism, and establishing postoperative care standards and clinical pathways. After implementing the strategies, the completion rates increased to 95%, and the knowledge score about neurosurgery postoperative care also improved to 89.1%. Implementing the complete education program and establishing the standard protocol have achieved a significant improvement in completion rate and reduction in infection rate.