提升轉出加護病房後，主要照顧者於呼吸道照護知能之專案

Improving the Knowledge of Primary Caregivers in Respiratory care After Discharge of Patients from the Intensive care unit

目的：轉出加護病房前使照顧者獲完善呼吸道照護訓練，能使非計劃性重返加護病房的比率明顯下降，期望藉此專案提升主要照顧者於呼吸道照護相關認知及照護能力。方法：經檢視轉出護理指導作業現況以及透過「呼吸道照護知能量表」及「影響照護者學習照護成效」調查，分析現況發現真因為：一、無轉出護理指導標準作業流程；二、無護理指導稽核表；三、學習時間不足及無實際操作；四、未採示範式教學；五、缺乏適切教學教材；六、護理師忙碌未確實執行。2019年2月至9月進行專案改善，於流程面：制訂「轉出護理指導標準作業規範」，並進行病歷紀錄稽核，以及延長會客時間與新增護理師支援機制；於工具面：增設衛教電視牆及QR-cord指導影片；教學面：規範技能示範與回覆示教項目，並依項目設計「轉出照護技能稽核表」，以確認照顧者學習成效。結果：「轉出加護病房後主要照顧者呼吸道照護知能正確率」由65.2％上升至90.1％；「非計劃性重返加護病房比率」由7.1％下降至4.7％。結論：透過優化加護病房轉出護理指導流程與內涵，提升護理師執行意願及有效提升主要照顧者對呼吸道照護之學習成效，期望能藉此專案成效提供其他同質性病房參考。（澄清醫護管理雜誌2022；18（1）：80-91）

"Purposes:Caregivers should undergo comprehensive respiratory care training before patients are discharged from the intensive care unit (ICU), as this can significantly reduce the rate of unplanned return to the ICU. This project aims to improve the awareness and care abilities of primary respiratory care caregivers. Methods:After reviewing the current standard operating procedures regarding nursing guidance on ICU discharge and designing the Respiratory Care Knowledge Score and Factors Affecting Learning and Nursing Effectiveness of Caregiver questionnaires, the root causes were determined to be as follows: (1) No standard operating procedures regarding guidelines for nursing on ICU discharge; (2) Limited learning time and no practical experience; (3) No guidance or checklists for nurses; (4) No teaching demonstrations; (5) Lack of suitable teaching materials; and (6) Nurses lacking available time for actual implementation. A project improvement plan was conducted between February and September 2019 that included process improvements such as the formulation of a“standard operating procedures for nurses on ICU discharge”document, audits of medical records, allowing extended time for family visits, creating nurse support systems, facility improvements such as health education video screens and QR codes for instructional videos, teaching improvements such as standardized demonstrations and feedback processes, and the creation of a“nursing checklist for ICU discharge”to ensure the learning effectiveness of primary caregivers. Results:The“accuracy rate of primary caregivers’knowledge of respiratory care after discharge from the ICU”increased from 65.2% to 90.1%. The“rate of unplanned return to the ICU”decreased from 7.1% to 4.7%. Conclusions:The willingness of nurses to perform and learning effectiveness of respiratory care among primary caregivers were improved by optimizing the standard operating proceduresregarding nursing guidance on ICU discharge. These results are expected to provide a reference for other similar facilities. (Cheng Ching Medical Journal 2022; 18(1): 80-91)"