提升某復健病房導尿物品準備完整性之方案

A Proposal for Elevating the Completeness of Preparation for Urinary Catheterization in a Rehabilitation Ward

脊髓損傷病人因神經損傷致排尿困難或失禁，臨床上每隔3至4小時施行間歇導尿，以解決其排尿困難或失禁之問題。本病房每日有16-24人次執行導尿技術，常見護理人員因導尿物品準備不齊，中斷導尿流程，往返取用物品，延長整體導尿時間，增加護理人員體力消耗與病人泌尿道感染之機會。經一週時間調查統計發現，導尿物品準備完整性僅52%，其原因包括：導尿物品置放不集中、人員用物準備不齊、工作車醫材不敷實際使用、不斷重複準備導尿用物，導致整體導尿時間延長。因此應用5S原則，規劃、設計導尿治療車。專案實施後，備物完整性提升至88%，品質改善率為69%；導尿過程含用物準備至整理完畢，只花費原本所需時間之34.87%；護理人員對工作車滿意度亦高達91.29%，真正達到省時、完整與高滿意度的品質提升。依專科特性設計之治療車，是值得推廣的。

Intermittent urinary catheterization is necessary for spinal cord injury patients, because of theirurinary incontinence or difficulty. Intermittent urinary catheterization is a daily-routine procedure inour ward with an average of 16 to 24 times per day. It is quite common to see nursing staff goingback and forth between the nursing station and bedside for different equipments required for theprocedure. Therefore the incompleteness from preparation results is not only time consuming butalso risky in getting infection from such procedures. Our investigation found that only 52% ofpreparation was completed in a one-week period. In most circumstances the incompleteness wasdue to the following reasons: scattered device location, personalized equipment shortage, runningout of cart storage, and repeated procedures. Thus our investigation proposed the '5S' principle fora specialized cart design with a planned amount of storage. After utilizing this newly designed andequipped cart, we elevated the completeness to 88%, spending only 34.87 % of the original time,thus improving the fluentness and nurses'satisfaction rate to 91.29%. Finally we concluded that thespecialized, profession-oriented cart could meet the purpose of time saving and high satisfaction.Thus it is worthy of advocating.