提升護理人員於高危險性新生兒待命流程之完整率

Improving the Standby Process Completion Rate Among Nurses for High-Risk Neonates

10.6224/JN.202404_71(2).10

吳茉凡(Mo-Fen WU)；鍾麗英(Li-Ying CHUNG)

高危險性新生兒 ； 情境模擬 ； 待命 ； high-risk neonates ； scenario simulation ； standby

護理雜誌

71卷2期（2024 / 04 / 01）

81 - 89

繁體中文;英文

背景：待命準備流程與高危險性新生兒安全息息相關，更需要受過專業訓練的醫護團隊即刻處置。根據現況分析，單位護理人員在執行高危險性新生兒待命流程的完整率低。原因為無高危險性新生兒待命標準作業流程及無稽核制度、缺乏教育訓練、待命包醫療用品多、缺少待命包清單、待命包未定時清點。目的：提升護理人員執行高危險性新生兒待命流程之完整率。解決方案：經專案成員討論並採行六項方案：（1）制定高危險性新生兒待命標準流程及錄製待命標準化流程影片。（2）建立稽核制度。（3）定期舉辦情境模擬教育訓練。（4）整理待命包之醫療用品。（5）設計待命包之點班清單。（6）明訂待命包之醫療用品點班及使用規範。結果：護理人員執行高危險性新生兒完整率提升至100%；護理人員執行高危險性新生兒待命流程之滿意度由59.5%提升至96.5%。結論：透過遵循正確的標準作業流程和進行教育訓練，才能夠在關鍵時刻確保有效且高品質的照護。

Background & Problems: Readiness process effectiveness significantly impacts the safety of high-risk neonates and requires an immediately responsive and well-trained healthcare team. Analysis of our unit found the high-risk neonatal standby process completion rate among nursing staff to be very low. Reasons for this poor level of performance included absence of standardized procedures for high-risk neonatal standby, lack of an auditing system, inadequate education and training, multiple medical supplies in the standby kits, absence of a checklist for the kits, and failure to regularly inventory the contents of these kits. Purpose: This study was designed to improve the high-risk neonatal standby process completion rate among nursing staff. Resolution: We developed standardized procedures and videos for high-risk neonatal standby situations, established an auditing system, conducted regular scenario-based training, organized medical supplies in the standby kits, designed a checklist, and defined procedures for stocking and using the supplies. Result: The high-risk neonatal care completion rate among nursing staff increased to 100%, and the satisfaction rate with the standby procedure for high-risk neonates rose from 59.5% to 96.5%. Conclusion: Following proper standardized procedures and conducting education and training can ensure effective and high-quality care in critical healthcare situations.

1. Aziz, K., Chadwick, M., Downton, G., Baker, M., & Andrews, W. (2005). The development and implementation of a multidisciplinary neonatal resuscitation team in a Canadian perinatal centre. Resuscitation, 66(1), 45–51. https://doi.org/10.1016/j.resuscitation.2004.12.017
   連結：
2. Gurung, R., Gurung, A., Basnet, O., Eilevstjønn, J., Myklebust, H., Girnary, S., Shrestha, S. K., Singh, D., Bastola, L., Paudel, P., Baral, S., & KC, A. (2020). REFINE (Rapid Feedback for quality Improvement in Neonatal rEsuscitation): An observational study of neonatal resuscitation training and practice in a tertiary hospital in Nepal. BMC Pregnancy and Childbirth, 20(1), Article 756. https://doi.org/10.1186/s12884-020-03456-z
   連結：
3. Kapadia, V., Oei, J. L., Finer, N., Rich, W., Rabi, Y., Wright, I. M., Rook, D., Vermeulen, M. J., Tarnow-Mordi, W. O., Smyth, J. P., Lui, K., Brown, S., Saugstad, O. D., & Vento, M. (2021). Outcomes of delivery room resuscitation of bradycardic preterm infants: A retrospective cohort study of randomised trials of high vs low initial oxygen concentration and an individual patient data analysis. Resuscitation, 167, 209–217. https://doi.org/10.1016/j.resuscitation.2021.08.023
   連結：
4. KC, A., Wrammert, J., Nelin, V., Clark, R. B., Ewald, U., Peterson, S., & Målqvist, M. (2017). Evaluation of helping babies breathe quality improvement cycle (HBB-QIC) on retention of neonatal resuscitation skills six months after training in Nepal. BMC Pediatrics, 17(1), Article 103. https://doi.org/10.1186/s12887-017-0853-5
   連結：
5. Marshall, S., Lang, A. M., Perez, M., & Saugstad, O. D. (2020). Delivery room handling of the newborn. Journal of Perinatal Medicine, 48(1), 1–10. https://doi.org/10.1515/jpm-2019-0304
   連結：
6. Van Heerden, C., Maree, C., & Janse van Rensburg, E. S. (2016). Strategies to sustain a quality improvement initiative in neonatal resuscitation. African Journal of Primary Health Care & Family Medicine, 8(2), Article a958. https://doi.org/10.4102/phcfm.v8i2.958
   連結：
7. Vento, M. (2020). The first golden minutes of preterm infants: Changing the concepts of resuscitation. In E. Herting & W. Kiess (Eds.), Innovations and frontiers in neonatology (pp. 13–24). Karger Publishers. https://doi.org/10.1159/000495430
   連結：
8. Whitesel, E., Goldstein, J., Lee, H. C., & Gupta, M. (2022). Quality improvement for neonatal resuscitation and delivery room care. Seminars in Perinatology, 46(6), Article 151629. https://doi.org/10.1016/j.semperi.2022.151629
   連結：
9. 台灣新生兒科醫學會（2023，8月22日）．新生兒高級急救救命術（NRP）流程表（第八版）。[Taiwan Society of Neonatology. (2023, August 22). Neonatal resuscitation program flowchart (8th ed.).] http://www.tsn-neonatology.com/upload/health/27.pdf?v=230822125730
10. 衛生福利部統計處（2021，8月19日）．109年死因統計結果分析。[Department of Statistics, Ministry of Health and Welfare, Taiwan, ROC. (2021, August 19). 2020 cause of death statistics.] https://www.mohw.gov.tw/dl-71446-e142a47c-14b3-4cef-8d80-f8e5747e8eb2.html
11. NHS Greater Glasgow and Clyde. (n.d.). Criteria for attendance at delivery by neonatal staff. NHSGGC Paediatrics for Health Professionals. https://www.clinicalguidelines.scot.nhs.uk/nhsggc-guidelines/nhsggc-guidelines/neonatology/criteria-for-attendance-at-delivery-by-neonatal-staff/