提升護理人員執行首次居家化療病人使用攜帶式輸液器衛教指導完整率

Promotion of the Health Education Completion Rate Among Home-based Patients Receiving Chemotherapy With a Portable Infusor

10.6142/VGHN.201809_35(3).0009

陳婷婷(Ting-Ting Chen)；標瓊喜(Chiung-Hsi Piao)；賴妙惠(Miao-Hui Lai)；葉婉真(Wan-Chen Yeh)

攜帶式輸液器 ； 居家化療 ； 衛教指導 ； portable infusor ； home-based chemotherapy ； health education

榮總護理

35卷3期（2018 / 09 / 01）

302 - 313

繁體中文

本專案目的提升護理人員執行首次居家化療使用攜帶式輸液器衛教指導完整率，預防化療藥物外滲之意外事件發生，增進病人居家自我照護能力及生活品質。統計本院2015年首次使用居家化療攜帶式輸液器病人，異常事件有103人（6.7%） 其中化療藥物外滲有2人（0.19%），高於本院病人安全品質指標閾值（0%），故引發改善之動機。經實際稽核護理人員於執行首次居家化療攜帶式輸液器衛教指導完整率僅50.8%。分析原因在護理人員方面衛教過程易被瑣事中斷、內容繁瑣；病人方面年紀大、學習動機低居多；衛教資源方面缺乏衛教指導手冊及工具；政策方面則缺乏衛教指導教育訓練及標準作業流程。其改善方法為制定標準作業流程並加強護理人員教育訓練，錄製多媒體影音光碟並放置於醫院衛教網站提供病人隨時觀看，製作衛教指導單及衛教模型。實施改善方法後執行首次居家化療攜帶式輸液器衛教指導完整率提升為97.4%，異常事件發生率降低至1.7%且無外滲異常事件發生，有顯著成效，並納入單位之品質指標持續監測。

The aim of this project was to promote the completion rate of health education among home-based patients receiving chemotherapy through portable infusions. The main purpose was to prevent chemotherapy extravasation and enhance patients' self-care capacity and quality of life. In 2015, according to the statistical data of patients who received home-based chemotherapy with a portable infusor for the first time, there were 103 abnormal events (6.7%), including two incidences of chemotherapy extravasation (0.19%), which was higher than the hospital index of patient safety (0%). Therefore, this motivated us to develop this improvement project. Clinical auditing revealed that the completion rate of portable infusion health education was only 50.8%. The following reasons for this low education completion rate were identified: because nursing staff members were busy with multiple tasks, they were easily interrupted during the education processes; some patients were older and had less motivation for learning self-care knowledge regarding using the infusor; educational resources such as handouts or tools were lacking; and in the policy dimension, there was no standard operating procedures for health education and insufficient continuous nursing education. The following improvement approaches were developed: formulate standard operating procedures for patients' health education and enhance nursing continuous education; record a video illustrating home-based infusor operation and publish the video on the Internet; and develop health education handouts and provide an educational infusor model for display. After the improvement program was implemented, the education completion rate among home-based patients receiving chemotherapy with an infusor for the first time increased to 97.4%, and the abnormal events decreased by 1.7% with no chemotherapy extravasation. These results indicated a significant improvement in infusor education, and the health education completion rate was included in the quality auditing index of the outpatient chemotherapy care unit for continuous monitoring.

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