提升內科加護病房二年期護理師俯臥照護正確率之專案

Project to Improve the Accuracy of Prone Positioning Care Provided by Postgraduate-Year-Two Nursing Staff in the Medical Intensive Care Unit

背景：急性呼吸窘迫症候群（acute respiratory distress syndrome）死亡率高達30%，且耗費醫療資源甚鉅，俯臥治療（prone position）被證實可有效改善病人氧合並降低死亡率。現況分析顯示，本單位2023年俯臥照護異常事件發生率上升20.4%，且皆發生於二年期新進護理師照護期間，因此引發動機來提升俯臥照護能力。
目的：提升俯臥照護之認知與執行技能，兩者平均正確率均達85%以上。
解決方案：藉由俯臥照護教育訓練課程與小班制教學、製作俯臥照護技術影片、設計俯臥照護流程評核表、開發創新擬真娃娃進行技巧練習、建立俯臥照護定期稽核制度、定期辦理模擬式學習實體操作課程，進而提升認知與技能。
結果：經專案改善後，二年期護理師的俯臥照護認知正確率由44.7%提升至93.1%，俯臥照護執行技能正確率由77.6%提升至93.7%，達成專案目標。
結論：建議未來持續辦理俯臥照護相關教育訓練與技能評核，並納入新進護理師培訓計畫中，以提升加護病房之專業照護品質。

Background & Problems: Acute respiratory distress syndrome, associated with mortality rates as high as 30%, consumes substantial healthcare resources. Prone positioning has been proven to effectively improve patient oxygenation and reduce mortality. A recent analysis in our unit found the incidence of adverse events related to prone positioning care had increased by 20.4% over the previous year and that all of these events were associated with care provided by postgraduate-year-two (PGY2) nurses.
Purpose: A program was initiated to enhance knowledge and practical skills related to prone positioning care among PGY2 nurses in our unit with the goal of improving the average accuracy rates of both knowledge and skills to at least 85%.
Resolution: Program components included: prone care education combined with small-group teaching, producing instructional videos on prone positioning care, designing a prone care competency checklist, developing innovative simulation dolls for skill practice, establishing a regular auditing system for prone care, and organizing periodic in-person skill workshops.
Results: After program implementation, the average accuracy of prone care knowledge increased from 44.7% to 93.1% in PGY2 nurses and the average accuracy rate of related practical skills improved from 77.6% to 93.7% in the unit.
Conclusions: Future prone positioning care education and skill assessments should be conducted regularly and incorporated into training programs provided to newly employed nurses. These measures should effectively strengthen the professional competency of intensive care nurses and improve overall patient care quality.