運用團隊資源管理降低住院高齡病人不當導尿管留置率

Using Team Resource Management to Reduce the Incidence of Inappropriate Urinary Catheter Use Among Hospitalized Older Patients

背景：不當導尿管留置易造成多項併發症，不僅延長住院天數，甚至增加住院死亡率。本單位2022年6–10月不當導尿管留置率達44.6%，且導尿管相關泌尿道感染（catheter-associated urinary tract infection, CAUTI）密度平均為3.6‰（高於全國平均值）。經現況分析發現不當導尿管留置率高的導因為：醫護人員未警覺導尿管移除重要性、缺乏提醒導尿管留置工具、缺乏導尿管移除相關的標準作業流程、與照顧者不清楚導尿管留置的必要性。
目的：降低不當導尿管留置率小於31%，且CAUTI密度平均值小於2.8‰。
解決方案運用團隊資源管理（team resource management）手法，透過領導、守望、互助、溝通，落實提醒導尿管留置機制、移除導尿管照護標準流程、移除導尿管後照護指引、與導尿管留置團體衛教。
結果：不當導尿管留置率下降至16.7%，CAUTI平均值降至1.9‰。
結論：本專案運用團隊資源管理手法，協同醫療人員、病人與家屬共同重視導尿管移除，能有效降低導尿管不當留置與CAUTI發生，以維護高齡病人安全。

Background & Problems: Inappropriate urinary catheter use not only prolongs the length of hospital stays but is also associated with increased rates of mortality. The incidence rate of inappropriate urinary catheter use in our unit was as high as 44.6%, and the incidence density of catheter-associated urinary tract infection (CAUTI) was 3.6‰from June to October 2022. The causes of inappropriate urinary catheter use in our unit were identified as: 1) healthcare professionals were not aware of the importance of catheter removal, 2) the lack of a reminder system for catheters, 3) the lack of a standard operating procedure for catheter removal, and 4) caregivers being unclear regarding the necessity of catheter use.
Purpose: This project was designed to reduce the incidence rate of inappropriate urinary catheter use to < 31%, and the incidence density of CAUTI to < 2.8‰.
Resolutions: Using team resource management through leadership; employing the watching, mutual assistance, and communication method; establishing a reminder system for catheters and a standard operating procedure for catheter removal; issuing guidelines for patient care after catheter removal; and conducting group education for catheters.
Results: The incidence rate of inappropriate urinary catheter use decreased to 16.7%, and the incidence density of CAUTI decreased to 1.9‰.
Conclusion: This project adopted the team resource management method and cooperated with healthcare professional and caregiver efforts to remove catheters. This project may be referenced as an effective means of reducing the risks of inappropriate urinary catheter use and CAUTI to enhance the safety of hospitalized older patients.