運用APP應用系統提升中心導管組合式照護的正確率之改善專案

A Project to Improve the Accuracy Rate of the Central Line Bundle Care with Mobile Application

中心導管是重症病人重要且不可或缺的醫療處置，也是血流感染的重要危險因子，正確的執行中心導管組合式照護能降低中心導管相關血流感染的風險。本單位2012 至2013 年中心導管相關血流感染為6.78‰，且有逐漸增加的趨勢，中心導管平均留置天數長達20 天，而照護正確率僅有65%。經分析發現與照護同仁不熟悉中心導管置入流程及缺乏照護技巧與認知有關。期望透過建置中心導管組合式照護APP輔助系統及舉辦相關教育訓練，實際應用於住院病人並對護理人員實施技術稽核以評估其成效，來達成此專案降低中心靜脈導管相關血流感染率至4.51‰及中心導管組合式照護正確率達90%的目的並確保病人安全。經專案介入後，中心導管相關血流感染率從6.78‰降至3.94‰，平均留置天數從20 天降至14 天，照護正確率由65%提升至95%。此專案改善成效良好，未來能推廣至全院一般急性病房。

 

The central venous catheter (CVC) procedure is a crucial and necessary medical treatment for patients with critical illness, but it is also a key risk factor for bloodstream infection. The CVC bundle care can decrease the risk for central line-associated bloodstream infection (CLABSI). However, the CLABSI rate in our medical unit was 6.78‰, with an increasing trend from 2012 to 2013. The average CVC indwelling time was up to 20 days and the accuracy rate of optimal CVC care was only 65%. Our analysis showed that these suboptimal practices were related to our nursing staff’s unfamiliarity with central line placement procedures and lack of related skills and knowledge regarding central line care. The goals of the project were to decease CLABSI to 4.51‰ and increase the accuracy rate of CVC bundle care to 90% in order to ensure the patients’ safety. To achieve these goals, we developed the CVC bundle care mobile application and implemented the corresponding on-the-job training to apply to our inpatient care. We also evaluated the nursing staff’s CVC bundle care skills to assess the project outcomes. After implementing the project, the rate of CLABSI decreased from 6.78‰ to 3.94‰, the average CVC indwelling time decreased from 20 days to 14 days, and the accuracy rate of CVC bundle care increased from 65% to 95%. As these results support the efficacy of the project, implementing to all acute care units in the hospital can be considered.