運用特定固定法降低兒科病房非預期性靜脈留置針之重新注射率

Improvement Program to Reduce the Unintentional Reinjection Rate of Intravenous Indwelling Needle in a Pediatric Ward

靜脈導管若常阻塞滲漏需重覆注射會增加病童不適，本專案目的降低非預期性靜脈留置針重新注射率，經現況分析2017年單位重新注射率高達17.9%，原因為靜脈注射認知不足、缺乏靜脈留置針標準技術規範、無固定板選擇標準、無統一黏貼固定方式、無稽核制度、缺乏靜脈留置針護理指導工具及缺乏多規格固定板。參考同儕醫院兒科病房靜脈重新注射率由3.44%降為0.88%，制定本單位專案依據目標值為現狀–（現狀×改善重點×圈能力）= 17.9%–（17.9%×80%×80%）= 6.4%以下。專案擬定改善策略：規劃教育訓練課程與舉辦靜脈留置針技能練習、增訂兒科靜脈留置針標準技術規範與增訂靜脈留置針腫脹嚴重度範圍分級表、增訂固定板選擇標準、增訂小兒靜脈留置針固定黏貼標準流程圖（例如：長度黏貼至固定板用浮貼方式勿往下壓等步驟）、制訂稽核制度、製作靜脈留置針衛教指導單張警示圖及製作多規格固定板。結果顯示重新注射率降至5.4%，提升了病童靜脈管路安全。建議未來於學會或公會的研習活動，予經驗交流課程，提升靜脈管路安全之醫療照護目標。

Repeated injections resulted from blockage or leaking of intravenous catheter will increase the discomfort of the child. The purpose of this study is to reduce the unintentional reinjection rate of intravenous indwelling needles. According to the analysis of the current situation in our unit, the reinjection rate in 2017 was as high as 17.9%. The identified causes including insufficient awareness of intravenous injection, lack of standard technical specifications for intravenous indwelling needles, no selection criteria for fixation plates, no standard fixation for intravenous injection, no audit system, lack of guidance tools for intravenous indwelling needles, and lack of multi- specification fixation plates. The peer hospital's pediatric ward intravenous re-injection rate reduced from 3.44% to 0.88%. The target value of this unit’s project was based on the current situation−(current situation×improvement focus×circle capacity) = 17.9%−(17.9%×80%×80%) = 6.4% or less. Formulated improvement strategies were: planning education training courses and holding workshop for intravenous indwelling needle skills, updating the standard technical specifications of pediatric intravenous indwelling needles and updating the swelling severity range grading table of intravenous indwelling needles, updating the selection criteria for fixation plates, and adding a standard flow chart for pediatric intravenous indwelling needles(for example, the length is pasted to the fixed plate with a floating pasting method, do not press down.), formulation of an auditing system, production of health education leaflets for intravenous indwelling needles, and production of multispecification fixation plates. The results showed the reinjection rate dropped to 5.4%, indicating improved safety of intravenous catheters for pediatric patients. It is recommended in future study activities of the society or association, experience exchange courses should be given to improve the medical care goals of intravenous line safety.