降低護理人員化療靜脈給藥之不完整率

A Project to Reduce the Incompletion Rate for Intravenous Chemotherapy Administration by Nurses

靜脈注射化學治療藥物是癌症病患最常見且重要的給藥方式，不完整的流程容易使得人員在執行過程中造成病患傷害，因此完整的化學治療靜脈給藥流程對提升病人安全是相當重要，本文旨在降低病房護理人員執行化療靜脈給藥流程之不完整率。現況查檢護理人員執行化療靜脈給藥流程不完整率達31.2%，經問卷調查原因分析有：缺乏注射部位評估工具、穿戴防護用具太麻煩及不完備、醫囑開立不一致、滴數計算錯誤、缺乏完整化學治療給藥標準作業及未有教育訓練。小組成員擬定及執行改善對策包括：跨領域團隊合作模式、新增及修定化學治療給藥標準、請購防護用具及防護物資擺設、發展專科紀錄與注射部位評估工具、辦理在職及安全防護訓練等，經由改善對策後，護理人員化療靜脈給藥不完整率由31.2%降至1.3%，達本專案目標，安全的執行化學藥物治療，提供給病患安全的就醫環境，本專案結果可提供臨床護理人員執行化學藥物給藥之參考。

Intravenous administration of chemotherapeutic medications is a common and important practice in oncology, but an incomplete protocol may also harm patients during that process. A complete protocol for intravenous administration of chemotherapeutic medications is important to enhance patient safety. This aim of this project was to improve nurses’ performance in the administration of intravenous chemotherapy. A check list was developed to assess the procedure for chemotherapy. The incompletion rate was 31.2%. Reasons for this included the lack of an injection site assessment tool, cumbersome protective equipment, inconsistent prescriptions, infusion rate calculation errors, the lack of a complete standardized protocol and inadequate training. Team members then planned strategies for improvement. These included a multidisciplinary team care model, revision of the chemotherapy standards of care, the purchase of protective equipment, development of a specialist record and injection site assessment tool, and further training. After the strategies were implemented, the incompletion rate decreased from 31.2% to 1.3% and the objective of this project was achieved. The results of this project can provide clinical nursing staff with a reference for the implementation of chemotherapy protocols.