提升重症護理師於連續性腎臟替代治療之警報處理執行正確率

Improvement of Medical Alarm Management Accuracy for Critical Care Nurses in a Continuous Renal Replacement Therapy Unit

背景：連續性腎臟替代治療是重症病人常見醫療處置，其中警報處理具緊急及時效性，若重症護理師處理不當，則會危及病人安全與存活率，但臨床無法提供護理師練習機會而出現培訓困難。2018年5月調查本單位護理師於連續性腎臟替代治療之警報處理執行正確率僅53.1％，調查原因為缺乏標準流程及參考工具、缺乏實際操作練習機會、缺乏辦理不同程度在職課程、業界無法即時協助、不熟悉各警報原因及處理等，故引發專案小組改善動機。目的：提升重症護理師於連續性腎臟替代治療之警報處理執行正確率90％以上。解決方案本專案自2018年9月8日至2019年8月31日間，經原因分析後擬定多元教學策略，如：建立標準流程與技術考、規劃翻轉教學之案例情境模擬課程實機操作、提供情境模擬影片、設計線上情境模擬互動教學、照護手冊及簡易操作隨機卡等。結果：重症護理師於連續性腎臟替代治療之警報處理執行正確率由53.1％提升至98.9％。結論：依照學習者需求，建立標準流程及規劃多元教學策略，實體翻轉教學實作課程及線上情境模擬教學，可有效提升重症護理師進階照護認知及操作能力，提供病人安全及提高照護品質照護，並平行推展至其他重症單位。

Background & Problems: Continuous renal replacement therapy (CRRT) is a common medical treatment for critically ill patients. The alarm management component of CRRT is urgent and time sensitive. Patient safety and survival rates are jeopardized if critical care nurses do not handle this situation properly. However, clinical settings cannot provide nurses with the opportunity to practice alarm management, which results in related training difficulties. Based on a survey conducted in May 2018, the rate of proper alarm management for the nurses in our CRRT unit was only 53.1%. An investigation attributed this low rate to inadequacies in standard procedures, resources for reference, opportunities for hands-on experience, professional training at different levels, immediate assistance from industry, and lack of familiarity with the purpose and handling of alarm incidents. These findings motivated our project team to improve alarm management. Purpose: To increase the accuracy of alarm management in CRRT critical care nurses to more than 90%. Resolutions: This project, which was implemented from September 8th, 2018 to August 31st, 2019, adopted a diverse and effective teaching strategy that included establishing standard procedures and technical tests; creating a plan for a case scenario simulation course using flipped teaching; providing scenario simulation videos; and designing online scenario simulation interactive exercises, nursing manuals, and flashcards of simplified procedures. Result: The accuracy rate of proper alarm management for CCRT critical care nurses increased from 53.1% to 98.9%. Conclusion: Diverse teaching strategies may be used to effectively enhance the care provided by critical care nurses, increase patient safety, and improve the quality of care. The findings and strategies in this study may also be applied to other intensive care units.