提升心臟內科加護病房目標溫控治療照護流程完整率之專案

Improving the Completion Rate of Targeted Thermal Management Nursing Processes in Cardiology Intensive Care Units

目的
到院前心肺功能停止經急救復甦後仍昏迷的病人，依據2020年美國心臟協會指南建議應盡快使用目標溫控治療（TTM）以減少腦部損傷，調查2021年改善前TTM照護流程完整率僅32.8％，故進行專案改善以提升心臟內科加護病房目標溫控治療照護流程完整率，提升病人醫療照護品質。
方法
分析照護流程完整率低之原因包括對TTM治療照護認知不足、儀器操作不熟悉、收案標準不一致、耗材及儀器放置分散、無法掌控目標溫度時間、醫囑開立不完整及無標準照護流程等。於2021年8月1日至2022年4月30日專案執行期間，經由介入改善對策包含辦理在職教育訓練、制定收案及照護標準、設立TTM專用箱、制定標準作業流程、制定TTM照護查核表、建立醫囑套組及優化護理資訊系統等。
結果
對策實施後，TTM照護流程完整率由32.8％提升至100.0％，護理人員照護認知正確率由78.2％提升至100.0％。
結論
本專案由跨團隊成員組成專案小組進行改善介入，在改善過程中遇到之最大困難為值班醫師團隊對於TTM使用時機及醫囑開立的部分皆有不同的想法，經由加護病房主任及專責醫師於品質會議與其進行討論及實證文獻進行分享，讓醫師們在TTM使用上更有共識，提升醫囑開立一致性，使專案改善能更順利進行，亦提升心臟內科加護病房TTM治療照護流程完整率，提升病人照護品質。

Purposes
According to the 2020 American Heart Association guidelines, patients who remain comatose after resuscitation from out-of-hospital cardiopulmonary arrest should be treated with targeted thermal management (TTM) as soon as possible to minimize brain damage. A 2021 survey found that the completion rate of TTM nursing processes prior to improvement was only 32.8%. Thus, the present study aims to increase the completion rate of TTM nursing processes in cardiac intensive care units (ICU), thereby improving the quality of medical care for patients.
Methods
The reasons for the low completion rate of TTM nursing processes included insufficient knowledge of TTM nursing care, unfamiliarity with instrument operation, inconsistent case admission standards, scattered placement of consumables and instruments, inability to control the target temperature and duration, incomplete medical orders, and lack of standardized nursing processes. During the implementation period between August 1, 2021 and April 30, 2022, the interventions included organizing on-the-job education and training, formulating admission and nursing care standards, setting up designated TTM kits, developing standard operating procedures, TTM nursing care checklists, and standardized order sets, and optimizing the nursing information system.
Results
After implementation of the initiative, the completion rate of TTM nursing processes increased from 32.8% to 100.0%, and the accuracy of nursing knowledge among nursing personnel increased from 78.2% to 100.0%.
Conclusions
The initiative was implemented by an interdisciplinary team, and the greatest challenge encountered was the conflicting opinions on the timing of TTM and the issuance of medical orders among the physicians involved. Through discussions led by the ICU director and specialized physicians during quality meetings as well as sharing evidence-based literature, a broad consensus among the physicians on the use of TTM was achieved. This resulted in improved consistency of medical orders, thereby facilitating implementation. Additionally, this improved the completion rate of TTM nursing processes in the cardiology ICU, ultimately improving the quality of patient care.