應用行動學習降低外科病房中心靜脈導管非計畫管路滑脫率

Applying Mobile Learning to Reduce the Incidence of Unplanned Central Venous Catheter Removal in Surgical Wards

本外科病房病人術後由加護病房攜帶中心靜脈導管轉入。2022年第1、2季非計畫管路滑脫率為0%、0.17%，第3季驟升至0.29%，高於同儕平均0.18%。有1例緊急重置導管的過程，引發家屬責怪與抱怨，造成研究對象照護壓力遽增，故組成專案研究小組進行改善。分析中心靜脈導管，非計畫管路滑脫滑脫率高的原因有：中心靜脈導管照護規範不完整、護理人員對急性譫妄病人的評估和約束判斷不足、照護認知不一致，以及缺乏導管照護教學工具。執行期間為2023年2月至9月，經應用聊天機器人的行動學習方案、修訂導管照護作業規範、製作教學影片以及敷料黏貼教具，成功將非計畫管路滑脫率，降低為0%，護理人員對導管照護的知能也隨之提升，達成研究目標。

Postoperative patients in our surgical ward are transferred from the ICU with central venous catheters (CVCs). In 2022, the incidence of unplanned CVC removal was 0% in the first quarter and 0.17% in the second, but it rose sharply to 0.29% in the third quarter, exceeding the peer average of 0.18%. One emergency catheter reinsertion incident prompted family complaints and increased stress among nursing staff, leading to the formation of a project team to address this issue. Root cause analysis identified multiple factors contributing to the high incidence, including incomplete care protocols, insufficient assessment, and restraint management for patients with acute delirium, inconsistent nursing practices, and a lack of educational tools for CVC care. To mitigate these issues, a quality improvement project was conducted from February to September 2023. Interventions included imple-menting a LINE chatbot mobile learning program, revising CVC care protocols, producing instructional videos, and designing adhesive dressing training aids. These efforts successfully reduced the incidence of unplanned CVC removal to 0% and enhanced nurses' knowledge and competencies in catheter care. The project demonstrated the effective-ness of targeted interventions in improving clinical outcomes and staff proficiency.