提升內科重症護理師照護體外循環維生系統病人之緊急狀況處理正確率

Increasing the Accuracy of Extracorporeal Membrane Oxygenation Critical Event Management in the Medical Intensive Care Unit

背景：體外循環維生系統（extracorporeal membrane oxygenation, ECMO）能暫時替代心肺功能，減少重要器官的損傷，重症護理師照護ECMO病人需有高度警覺性及觀察力，若不熟練而無法即時且正確地處理ECMO之緊急狀況，將會危及病人生命。本單位曾發生ECMO緊急狀況而影響病人安全且致護理師照護時壓力大，經現況分析發現單位護理師對ECMO緊急狀況處理正確率僅59.1%，導因為缺乏技術評核標準、在職教育不足、無實際操作經驗、缺乏多元化教材及未建立線上課程。
目的：提升重症護理師對ECMO緊急狀況處理正確率達86%以上。
解決方案根據此臨床問題導向擬定改善方案，藉由制定技術評核表及技術考、舉辦在職教育、情境模擬教學及製作多元教材等措施。
結果：重症護理師對ECMO緊急狀況處理正確率由59.1%提升至95.9%。
結　論／實務應用本專案有效提升重症護理師對ECMO的照護認知及危機處理能力，降低對警訊之壓力感受並增強問題處理的自信心，完善照護品質而保障病人安全。

Background & Problems: Extracorporeal membrane oxygenation (ECMO) is an intervention that replaces cardiopulmonary function temporarily to reduce injury to vital organs. As important members of the ECMO medical team, intensive care unit nurses must be well trained and alert to possible critical events. Failure to troubleshoot and manage ECMO promptly and correctly significantly increases the risk of mortality. A previous ECMO critical event in our unit resulted in lingering concerns and stress among nurses related to implementing this intervention. A survey conducted among our medical intensive care unit (MICU) nurses identified an implementation accuracy level for ECMO critical event management of only 59.1%. This poor result was attributed to a lack of technical assessment standards, in-service training, clinical experience, and instruction materials and the failure to offer online courses.
Purpose: This study was designed to increase the accuracy of ECMO critical event management implementation among intensive care unit nurses to > 86%.
Resolutions: We conducted a problem-based training project to improve ECMO critical event management that: introduced a technical assessment sheet and technical simulation exercise, organized in-service training, implemented irregular simulation exercises, and produced multiple different instructional materials.
Result: The accuracy of ECMO critical event management implementation among the intensive care unit nurses increased from 59.1% pretest to 95.9% posttest.
Conclusion: This project improved the ECMO care ability of MICU nurses in our hospital significantly, resulting in increased ECMO critical event management implementation accuracy, better patient care, higher nursing staff confidence, and lower perceived stress among nursing staff.