提升新生兒加護病房護理師協助放置體外維生系統照護完整率

Improve the Completion Rate of ECMO Placement Assistance for Nurses in the NICU

背景：體外維生系統（extracorporeal membrane oxygenation [ECMO]，又稱葉克膜）能提供重症新生兒心肺支持、降低死亡率。經現況調查單位護理師照護完整率僅63.5%，原因為認知不足、對放置ECMO作業不熟悉、不清楚準備用物、對ECMO管路固定不熟悉、放置ECMO用物單位內無設置、缺乏專科照護指引、無定期查核制度以及無定期在職教育。
目的：提升新生兒加護病房護理師協助放置ECMO認知及照護完整率。
解決方案：1.制作新生兒放置ECMO照護指引手冊，讓照護過程有所依循。2.規劃放置ECMO準備檢視表及ECMO專用工具盒，以減少用物準備時間及使流程更順暢。3.定期舉辦照護課程及擬定評核機制，以提升放置ECMO認知及技能熟悉度。
結果：新生兒加護病房護理師協助放置ECMO認知正確率由改善前51.9%提升至89.9%；放置ECMO照護完整率由改善前63.5%提升至100.0%。
結論：專案實施後能有效的提升護理師協助放置ECMO照護認知正確率，使放置ECMO照護更順暢，並提升照護之完整率，完善新生兒照護品質。

Background & Problems: The extracorporeal membrane oxygenation (ECMO) system can provide cardiopulmonary support to and reduce the mortality rate in severely ill newborns. According to our investigation, completion rate of the care process among staff nurses was only 63.5% in our ward. We assumed that the reasons for the above problems included: lack of care awareness, unfamiliarity with the ECMO operation process, inadequate instruments preparation, improper ECMO pipeline fixation, lack of designated space in the unit for placing ECMO supplies, lack of specialty care guidelines, lack of a regular inspection system, and lack of regular on-the-job education.
Purpose: Improve awareness related to assisting ECMO placement among nurses in the neonatal intensive care unit and the completeness of care.
Resolutions: 1. Create a care process guidebook describing the procedures for ECMO system placement in newborns to help nurse accomplish proper placement. 2. Establish the ECMO system consumables checklist and install an ECMO system-specialized toolbox to reduce the preparation time and smooth the process. 3. Regularly organize comprehensive nurse training and develop performance indicators to enhance ECMO system placement awareness and skills.
Results: The cognitive accuracy rate for the assisted placement of ECMO among nurses in the neonatal intensive care unit increased from 51.9% before improvement to 89.9% afterward. Also, the complete care rate of ECMO placement increased from 63.5% before improvement to 100% afterward.
Conclusion: This project effectively improved the accuracy rate of nurses involved in assisting with ECMO placement, made the ECMO system placement process easier to implement, improved the care process completion rate, and improved newborn care quality.