提升周邊置入中心靜脈導管照護完整率

Improvement of the Completeness Rate in the Care of Peripherally Inserted Central Catheters

本專案旨在提升周邊置入中心靜脈導管照護完整性，降低管路異常事件。因單位PICC異常發生率高7.33%，引發探討改善動機，調查發現護理師執行PICC照護完整率僅68.8%，對PICC認知正確率為67.8%，病人對PICC衛教滿意度僅48%。分析原因為：無PICC照護標準作業規範、未舉辦PICC照護教育訓練、衛教不足及工具不適切、欠缺稽核機制等。經制訂PICC照護規範、製作護理師及病人教育訓練教材、舉辦教育訓練、建立稽核機制方案後，護理師執行PICC照護完整率由68.8%升至98.3%，對PICC認知正確率由67.8%升至96.7%，異常發生率由7.33%降至3.48%，病人對PICC衛教滿意度由48%升至96%。改善成效卓越，不僅提升PICC照護品質及病人滿意度，更提昇整體醫護照護品質。

The purpose of this project was to improve care of peripherally inserted central catheters and reduce the occurrence of pipeline abnormalities. Our hospital found a high incidence (7.33%) of PICC abnormalities in our patients, indicating a need for improvement in care. We administered a survey to understand the problem and found the completeness rate of PICC care performed by nurses to be only 68.8%, the correct PICC recognitive rate to be 67.8%, and the patient satisfaction with their PICC to be only 48%. An analysis of the causes of these poor rates revealed them to be a lack of a PICC standard of care, lack of PICC care education and training, lack of adequate patient health education and tools, and a lack of a mechanism for double checking patency of PICCs. We thus formulated and instituted standard procedures for PICC care, created teaching materials for nurses and patients, organized education and training courses and established programs for auditing care and patency of PICCs. Following up the results of our efforts, we found rate of caregiver complete implementation of PICC increased from 68.8% to 98.3% and correct recognitive rate of PICC rose from 67.8% to 96.7%. The incidence of abnormalities decreased from 7.33% to 3.48%, and the patient satisfaction with PICC increased from 48% to 96%. In conclusion, quality of care and patient satisfaction was greatly improved. Moreover, improvements were also generalized to other areas of patient care.