運用實證醫學為基礎——降低導尿管不必要使用率-以神經內科病房為例

Reducing the Unnecessary use of Foley Catheters in the Neurology Ward: Application of Evidence-Based Practice and Knowledge Translation

目的：以實證醫學為基石，探討神經內科病房導尿管置放適應症、移除時機和餘尿量監測法影響導尿管使用率，進而降低導尿管相關泌尿道感染率。
設計：文獻回顧和制定標準。
方法：根據臨床評估和經驗，使用“患者/人群、介入、比較和結果”設計了三個問題：1.制定導尿管適應症是否能降低腦中風病人尿管使用率2.導尿管留置時間長短是否與泌尿道感染有關3.膀胱容量測量儀是否比間歇導尿更能提升病患的舒適度與滿意度在Cochrane圖書館和Medline等多個數據庫中搜索了2003年至2019年發表的相關文獻。以CASP判讀文獻品質，並考量臨床可行性，制定：神經內科放置導尿管適應症和拔除導尿管的最佳時間，並製定了膀胱掃描方案以估計殘餘尿量。
結果：方案實施5個月後，導尿管不必要使用率由67.0%降為8.7%，導管相關泌尿道感染發生率由3.8‰下降至2.1‰；使用膀胱容量測定儀檢查之病人舒適度明顯高於接受導尿的病人(p<0.001)。
結論：防止不必要地使用導尿管可以降低感染率，增加病人的舒適度，並促進更好的醫療品質。
影響：通過合理的留置導尿，預計可降低嚴重感染率並縮短住院時間，進而有效減少住院天數和個人醫療支出。

Aims: To apply evidence-based practice and knowledge translation to modify the indications for urethral catheterization, timing of catheter removal, and measurement of residual urine volume, with the goal of reducing the incidence of catheter-associated urinary tract infections (CAUTIs) in neurology wards.
Design: This project was conducted using an evidence-based practice framework.
Methods: Three questions were formulated using the“patient/population, intervention, comparison, and outcomes”(PICO) model based on clinical assessment and experience. Relevant literature published between 2003 and 2019 was searched across databases such as the Cochrane Library and Medline. Each study was appraised using the appropriate Critical Appraisal Skills Program (CASP) tools. The findings were used to determine the indications for urinary catheterization in neurology cases, identify the optimal timing for urethral catheter removal, and establish a protocol for bladder scanning to estimate residual urine volume.
Results: Five months after implementing the new protocol, the rate of unnecessary urethral catheter use in our hospital decreased from 67.0% to 8.7%, and the incidence of CAUTIs declined from 3.8‰to 2.1‰. Additionally, patient comfort was significantly higher among those assessed with the ultrasound scanner compared to those who underwent catheterization (p <0.001).
Conclusion: Reducing unnecessary urethral catheter use can lower infection rates, enhance patient comfort, and improve overall healthcare quality.