運用多元策略提升血液動力學監測儀照護正確率

Using Multiple Strategies to Improve the Accuracy of Hemodynamic Monitoring

背景：血液動力學監測照護為加護病房重要作業，近年來醫療科技發達，重症照護設備更加多元化，已有多種儀器可導入臨床監測血液動力學，單位全面導入新型血液動力學監測儀後，發現護理人員臨床使用時對儀器照護不熟悉，且曾發生護理人員未發現血液動力學參數改變之警示訊息，未及時通知醫師提供相對應處置之病安事件，進一步調查護理人員執行血液動力學監測儀照護正確率僅74.0%，故引發執行此專案之動機。
目的：提升護理人員執行血液動力學監測儀照護正確率達98.3%。解決方案辦理教育訓練及規劃專科在職教育、訂定稽核制度，定期監控護理人員照護正確率；製作「武功祕笈」改善操作手冊不易閱讀之問題，提升護理人員照護完整性；建立行動學習，讓學習達到即時性及可近性；辦理模擬實機演練提升護理人員儀器操作熟練度；建立監測數據自動上傳醫療資訊系統。
結果：改善後血液動力學監測儀照護正確率提升至98.7%。
結論：改善成果良好，推廣至院內其他加護病房，護理人員熟悉操作方式、參數意義及數據的判讀，當數值改變或出現異常時，立即通知醫師進一步評估，採取適當的照護措施，提升病人安全。

Background & Problems: Hemodynamic monitoring is an important part of nursing care in the intensive care unit. Recent advances in medical technology and the diversification of intensive care equipment have increased the variety of instruments used in clinical hemodynamic monitoring. Many nurses who use new hemodynamic monitors are not familiar with instrument care, resulting in patient safety incidents caused by nurses not identifying warnings of hemodynamic data change and notifying doctors to provide treatment. The accuracy of hemodynamic monitoring care in our ward of 74.0% motivated this improvement project.
Purpose: To improve the accuracy of hemodynamic monitoring care to 98.3%.
Resolution: Conduct educational training and plan professional education; establish an audit system to regularly monitor the accuracy of nursing care; provide tips to make the operation manual easier to read and understand; establish mobile learning to make learning immediate and more accessible; hold instrument operation practice sessions to improve nursing staff proficiency; monitor and upload data to the hospital information system.
Result: After the improvement project, the accuracy of hemodynamic monitoring care increased to 98.7%.
Conclusions: The impact achieved met expectations, and the improvement project will be extended to other intensive care units in the hospital. Our nurses are now more familiar with the operation methods and the significance of monitoring values and interpretation of data. Also, when a value changes or becomes abnormal, they immediately notify the doctor for further evaluation and interventions to improve patient safety.