提升兒童加護病房護理師執行連續性靜靜脈血液過濾術操作正確率

Improve the Accuracy of Continuous Venovenous Hemofiltration Performed by Nurses in the Pediatric Intensive Care Unit

兒童加護病房病人常因疾病導致急性腎損傷，需使用連續性靜靜脈血液過濾術（continuous venovenous hemofiltration, CVVH），矯正血中酸鹼值及移除過多水分。本單位護理師執行此治療常因事前準備及過程不熟練，導致病人延後治療及流失血液；經調查確認原因為兒童準備用物繁雜、僅口頭教學、照護認知不足、技能不熟悉、警訊排除能力不足及學習資料不適用等。專案旨在提升護理師執行CVVH操作正確率，改善策略包括：翻轉教室之實機操作訓練、「洗出腎利」APP、警訊處理QR code及LINE機器人等措施。護理師CVVH操作正確率，由69.0%提升至98.2%，由1.9天使用1套醫材，延長至3天，且準備用物至預沖時間，由1小時縮短成13分鐘，進而提升CVVH照護品質。

Patients in the pediatric intensive care unit often suffered from acute kidney injury due to disease. Continuous venovenous hemofiltration(CVVH) was required to maintain blood acid-base balance and remove excess water. However, our nurses in the pediatric intensive care unit often performed this treatment with unskilled preparation and execution process, which resulted in delayed treatment and blood loss. After detailed investigation and analysis, the problems were complicated pediatric preparation materials, used only oral teaching, insufficient nursing cognition, unskilled skills, insufficient ability to eliminate warning signs and inapplicable learning materials. The purpose of this project was to improve the accuracy rate of continuous venovenous hemofiltration performed by nurses. The improvement strategies that included flipped classrooms for physical machine operation training, establishment of the “washing out kidney benefits” application(APP), and also a quick response code(QR code) and a LINE robot to deal with alerts. The accuracy rate of continuous venovenous hemofiltration by nurses increased from 69.0% to 98.2%. The use of one set of tube was extended from 1.9 days to 3 days, and the time from preparing materials to pre-flushing was shortened from 1 hour to 13 minutes, and thus improved the quality of continuous venovenous hemofiltration care.