提升二年期受訓護理師外科引流管照護完整性

提升管路安全為醫院醫療品質及病人安全的工作目標，管路留置是外科手術常見的侵入處置，而外科引流管照護完整性是提升管路安全的重要指標之一。臨床調查發現二年期受訓護理師（N-PGY 2）對於外科引流管照護完整性以及外科引流管照護認知，分別是71.3%及66.3%偏低，導致醫護間出現不信任及拒絕N-PGY 2照護病人之負向氛圍，因此引發專案改善動機。經調查N-PGY 2對於外科引流管照護完整性低的主要原因有：缺乏針對專科性引流管異常處理流程、客觀結構式臨床測試課程（OSCE）缺乏病人實際照護面之病情變化處理、新進人員教育訓練內容多為文字檔及獨立前未遇過外科引流管異常情境等。經分析及討論後實施解決方案如下：一、制定外科引流管照護教育訓練內容；二、將教育訓練內容製作QR CODE；三、製作外科引流管照護須知快速翻閱資料簿；四、製作「醫師說帖」呈現外科引流管異常報備標準流程；五、與醫師制定有關外科引流管異常情境之客觀結構式臨床測試（OSCE）內容。結果顯示，經介入措施後，二年期受訓護理師的外科引流管照護完整性及外科引流管照護認知測驗正確率，皆分別提升至95.3%和94.5%，已達專案改善之目的。期盼藉此提升N-PGY 2外科引流管照護完整性的改善專案，降低發生病人管路異常事件，並促進病人安全。

Enhancing the safety of surgical catheters and drains represents a pivotal aim in the quest for healthcare quality and patient safety within hospitals. The insertion of catheters or drains is a routine yet invasive procedure in surgical practice, where the thoroughness of surgical drain management emerges as a critical measure of catheter and drain safety. A clinical survey revealed that nurses in the twoyear postgraduate training program (N-PGY2) displayed lower proficiency in both the understanding and execution of surgical drain care, with completion rates of 71.3% and cognition rates of 66.3%, respectively. This deficiency led to hesitance among physicians to entrust patient care to N-PGY2 nurses, contributing to a climate of distrust and negativity within medical teams. In response, a dedicated task force for improvement was established. The survey identified key areas for enhancement among N-PGY2 nurses: a lack of specialized knowledge in managing surgical drain care, absence of practical nursing courses addressing patient condition changes in Objective Structured Clinical Examinations (OSCE), reliance on textual materials for education and training, and inexperience with surgical drain complications prior to independent practice. The implemented solutions included: 1) Development of comprehensive educational and training materials for surgical drain care, 2) Introduction of a QR code linking to training resources, 3) Creation of a quick-reference guide for surgical drain care, 4) Establishment of ''Physician's Comments'' as a standard reporting procedure for drain abnormalities, and 5) Enhancement of OSCE content in collaboration with physicians to cover abnormal surgical drain scenarios. Post-intervention results showed a significant improvement in the N-PGY2 nurses' completion and cognition rates of surgical drain care, rising to 95.3% and 94.5%, respectively. This initiative is anticipated to lower the incidence of surgical drain complications and elevate patient safety standards.