降低肝膽腸胃科病房非計畫性週邊靜脈留置針重注率之改善專案

Reducing Unplanned Peripheral Intravenous Catheter Replacement Rate in Medical Wards

10.6142/VGHN.201906_36(2).0004

陳秋曲(Chiu-Chu Chen)；林詣茜(Yi-Qian Lin)；郭志強(Chih-Chiang Kuo)；陳瓊瑤(Chiung-Yao Chen)；林玉茹(Yu-Ju Lin)

非計畫性週邊靜脈留置針重注率 ； 週邊靜脈留置針 ； unplanned peripheral intravenous catheter replacement rate ； peripheral intravenous catheter

榮總護理

36卷2期（2019 / 06 / 01）

143 - 151

繁體中文

週邊靜脈留置針在輸液使用過程中，因各種因素未達72小時就需重新注射造成病人疼痛與抱怨，且非計畫性留置針重注率高達30.3%。本專案旨在降低單位非計畫性週邊靜脈留置針重注率，設定17.5%為目標值。經歸納出重注率高的主因，問題確立為（一）＜1年新進護理師的靜脈注射技術不正確；（二）靜脈注射技術未規範管路固定標準；（三）缺少刺激性藥物輸注之稀釋標準；（四）靜脈注射病人或家屬未接受相關衛教指導。故擬定解決辦法：（一）製作護理人員靜脈注射「七字口訣記憶教學影片」；（二）修訂「靜脈注射技術與管路固定作業標準」與教育訓練；（三）制訂「輸液與藥物稀釋一覽表」；（四）製作「病人PIVC的管路照護衛教單張」。專案結果非計畫性留置針重注率在效果維持期間降至16.7%；改善後的靜脈注射技術與管路固定照護正確率達87.5%，住院病人對於管路安全照護的個別性衛教全部瞭解比例也達100%。專案有效改善非計劃性週邊靜脈留置針重注率，減少病人因重新注射造成的疼痛，達到病人安全及滿意的照護品質。

Replacement of the peripheral intravenous catheter (PIVC) in ＜72 h during the infusion process may lead to pain and other complications in patients. This study aimed to reduce the unplanned PIVC replacement rate to 17.5%. An unplanned PIVC replacement may be required because (1) the intravenous injection technique of nurses with ＜1 year of experience is incorrect, (2) a standard procedure for the intravenous injection technique is unavailable, (3) nurses have insufficient understanding regarding the concentration of irritant drugs and methods of dilution, and (4) patients have insufficient knowledge regarding intravenous injection. Therefore, this project was implemented in four steps: (1) creating an educational video to teach the＂ seven-word pithy formula＂ to nurses, (2) revising the standard procedure for the intravenous injection technique as well as PIVC care standard and educational training, (3) preparing a list of irritant drugs used for infusion and achieving proper drug dilution, and (4) creating health education leaflets for PIVC care. The unplanned PIVC replacement rate was 30.3% during the reintroduction period, and it decreased to 16.7% during the maintenance period. On implementation of this program, the rate of accurate intravenous technique implementation and appropriate PIVC care improved to 87.5%. Moreover, the cognitive rate of individual health education for PIVC care improved to 100%. This project was implemented through problem solving and provided patient safety, which improved nursing care quality.

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