運用護理驅動準則降低加護病房導尿管使用率

Implementation of a Nurse-Driven Protocol to Decrease Indwelling Urinary Catheter Utilization in Intensive Care Units

泌尿道感染為醫療機構常見的感染之一，其中75%與導尿管留置有關，本單位2021年導尿管使用率為75.5%，較院內內科加護病房及台灣同儕醫學中心為高，經由現況分析確立導尿管使用率高的要因為：導尿管留置適應症及移除時機之認知有偏差、導尿管到期前無提醒機制、無導尿管移除後自解情況評估之共識及評估依據、不清楚膀胱超音波的用途及不熟悉操作。於2022年11月1日至2023年3月31日運用護理驅動準則介入：擬定導尿管移除流程、設計導尿管留置天數視覺化圖表、膀胱超音波教育訓練等。專案執行後導尿管使用率下降至66.4%，低於目標值71.8%，達成專案目的，效果也持續維持，2023年平均導尿管使用率為63.9%，2024年為67.4%；減少導尿管的使用，也因此降低了導管相關泌尿道感染密度，為專案之附加價值。永續發展目標是現今重要議題，建議本專案設計的視覺化圖表，可以由電子病歷系統自動產生，以即時呈現導尿管留置狀況，以為病人安全及照護品質把關。

Urinary tract infection is one of the common infections in hospital, 75% of which are related to indwelling urinary catheters. The urinary catheter utilization rate in our unit was 75.5% in 2021, which is higher than that of the medical intensive care unit and peer medical center in Taiwan. The analysis of the current situation confirmed that the main reasons for the higher rate of urinary catheter use were: the cognitive bias of the indications for urinary catheter indwelling and the timing of removal, the lack of a reminder mechanism before the expiration of the urinary catheter, and the lack of an assessment skill of urinating after urinary catheter removal, and not familiar with the operation of bladder ultrasound. From November 1, 2022 to March 31, 2023, nursing-driven interventions were implemented: developing a catheter removal protocol, designing a visualization chart of catheter indwelling days, and conducting bladder ultrasound education training. After the project was implemented, the urinary catheter utilization rate dropped to 66.4%, lower than the target value of 71.8%, achieving the project goal and maintaining the effect. The average catheter utilization rate was 63.9% and 67.4% in 2023 and 2024 respectively. The reduced use of urinary catheters also decreased the catheter-associated urinary tract infections, which is an added value for this project. Sustainable development goals are an important issue today. It is recommended that the visual chart designed in this project can be automatically generated by the electronic medical record system to present the status of urinary catheter placement in real time to ensure patient safety and quality of care.