運用JBI實證應用模式改善病房完全植入性靜脈通路裝置血流感染率

Using the JBI Empirical Application Model to Reduce Rate of Bloodstream Infection of Totally Implantable Venous Access Ports in Hospital Ward

10.6142/VGHN.202309_40(3).0008

魏方君(Fang-Chun Wei)；江宜瑾(Yi-Jinn Jlang)；劉素蘭(Su-Lan Liu)；張堯婷(Yao-Ting Chang)；穆佩芬(Pei-Fan Mu)

完全植入性靜脈通路裝置 ； 血流感染 ； 實證應用 ； 變革領導 ； totally implantable venous access ports ； blood infection ； practical application of clinical evidence system ； transformational leadership

榮總護理

40卷3期（2023 / 09 / 01）

293 - 305

繁體中文;英文

血流感染是院內感染相當重要的課題，完全植入性靜脈通路裝置（totally implantable venous access ports, TIVAPs）的執行是護理人員常規執業範圍之一，當TIVAPs導管感染，將延後治療時機、延長住院天數或後續引發敗血症等生命威脅。因此，護理人員照護放置TIVAPs時，預防感染程序是相當重要。本專案目的乃基於實證證據項目來降低完全植入性靜脈通路裝置感染率。專案應用JBI實證應用模式進行，共分三階段：一、成立TIVAPs導管的團隊，並依據實證證據進行基線稽核；二、將第一階段的稽核結果在臨床上遵從率未達80%的部分，於團隊中進行深入討論，確立出品質改善的障礙及資源，並應用循環式品質管理模式，發展相關的介入策略並進行改善策略的推動；三、進行後續追蹤稽核並評值血流感染發生率。專案實施於台中某醫學中心一個內外科綜合病房，專案進行前單位感染密度為（千分之4.01），其中TIVAPs導管的血流感染佔10位（71.4%），自2021年10月18日至2022年5月31日進行此實證專案改善，共20位護理人員及20位病人參與稽核。此實證應用之改善專案具成效，進行改善的三項臨床指引項目均達100%。且2022年6月到12月TIVAPs造成的血流感染人數為0人，TIVAPs感染密度為（千分之0）。實證指引的落實、教育內容的完整性及運用變革領導模式，讓護理人員主動激發創意及共同解決困難，來提升醫療照護品質與照護能力。

Bloodstream infection can be hospital acquired. The placement of totally implantable venous access ports (TIVAPs) is a routine procedure performed by nurses, especially for cancer patients and those receiving serious treatment. When TIVAPs become infected, treatment is delayed, hospitalization is prolonged, and life-threatening conditions such as sepsis can arise. Therefore, nurses must implement infection prevention procedures during the placement of TIVAPs. This project aimed to reduce the rate of infection of TIVAPs on the basis of evidence-based practices. The project followed the JBI Evidence Implementation guidelines in the following three stages: first, the establishment of a team for TIVAP placement and a baseline audit based on evidence-based practices; second, in-depth discussions within the team on areas where clinical compliance is less than 80% and identification of obstacles to and resources necessary for quality improvement, the application of a cyclical quality management model, the development of relevant intervention strategies, and the implementation of improvement strategies; and third, follow-up audits for evaluating the incidence of bloodstream infections. The project was implemented at a medical center in Taichung, Taiwan, in a general ward that include both internal medicine and surgery patients. Before the project, the unit infection density was (4.01 per mille), with TIVAP bloodstream infections accounting for 10 cases (71.4%). The evidence-based project was conducted from October 18, 2021, to May 31, 2022, with 20 nurses and 20 patients participating in the audit. The improvement project was effective, with compliance with all three clinical guideline items reaching 100%. Furthermore, from June to December 2022, no cases of bloodstream infections caused by TIVAPs occurred, and the infection density was (0 per mille). The successful implementation of evidence-based practices, complete educational content, and use of transformational leadership models to motivate nurses to generate ideas and collaborate to solve problems helped improve the quality of medical care and care capabilities.

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