提升新生兒加護病房護理人員執行低溫療法照護流程完整率

Increasing the Rate of Completion of the Therapeutic Hypothermia Procedure in the NICU

背景：對於周產期窒息造成的新生兒缺氧缺血性腦病變目前最具療效的是低溫療法，它可以降低新生兒死亡率及神經障礙，越早開始對神經保護效果越好。現況調查發現由於個案數不多以致單位護理人員照護經驗不足及對照護流程不熟悉，相關照護指引未更新及用物放置分散致用物準備不完整，無定期在職教育致護理人員對低溫療法照護認知不足。目的：提升新生兒加護病房護理人員對低溫療法照護認知及提升執行低溫療法照護流程完整率。解決方案：1.定期舉辦低溫療法照護課程及情境模擬課程，以提升護理人員低溫療法照護認知及熟悉度。2.規劃低溫療法專用準備包及文件盒、制訂低溫療法放置用品確認表，以減少用物準備時間。3.修定低溫療法照護流程指引手冊及建立監測機制。結果：新生兒加護病房護理人員對低溫療法照護認知正確率由改善前82.0％提升至94.5％|護理人員對低溫療法照護流程完整率由改善前75.6％提升至100.0％。結論：專案實施後能有效的提升護理人員對於低溫療法照護認知正確率，使低溫療法照護流程更順暢，並提升照護流程之完整率，完善新生兒低溫治療照護品質。

Background & Problems: The most effective treatment currently available for perinatal asphyxia-induced hypoxicischemic encephalopathy is therapeutic hypothermia, which reduces the mortality rate and neurological disorders in newborns. The earlier this therapy is performed, the better the protective effects on the nerves of the patient. In our neonatal intensive care unit (NICU), we discovered that nurses lack experience caring for patients undergoing hypothermia therapy due to the limited number of cases. In addition, outdated guidelines, the disorganized placement of equipment, and the paucity of hands-on simulations exacerbate the unfamiliarity of the nurses with this therapy. Purpose: To expand the knowledge of nurses regarding therapeutic hypothermia in the NICU and to increase the rate of completion of the therapeutic hypothermia procedure. Resolutions: 1. Regular care training programs and scenario-based simulations were conducted to help nurses obtain related knowledge and become more familiar with therapeutic hypothermia. 2. In order to reduce the preparation time, a specific preparation kit and an instruction folder for therapeutic hypothermia was developed that included a material placement checklist. 3. The procedure guidance booklet for therapeutic hypothermia was revised and a monitoring system was established. Results: The accuracy of nurses' knowledge regarding therapeutic hypothermia in the NICU improved from 82.0% to 94.5%. The completion rate for the therapeutic hypothermia procedure rose from 75.6% to 100.0%. Conclusions: This project successfully enhanced the accuracy of nurses' knowledge regarding therapeutic hypothermia and increased the rate of completion for this care procedure, resulting in a safer and more-standardized procedure for neonates undergoing therapeutic hypothermia.