運用創新擴散理論降低兒科周邊靜脈留置針重新固定率

Employ Diffusion of Innovations Theory to Reduce the Rate of Pediatric Peripheral Intravenous Catheters Re-fixation

10.29494/LN.202112_22(4).0009

鍾芷涵(Zhi-Han Chung)；劉姵妏(Pei-Wen Liu)；李佳褒(Jia-Boa Lee)；陳芝文(Chih-Wen Chen)

兒科周邊靜脈留置針 ； 重新固定 ； 創新擴散理論 ； pediatric peripheral intravenous catheters ； re-fixation ； diffusion of innovations theory

領導護理

22卷4期（2021 / 12 / 01）

118 - 133

繁體中文

本專案目的在降低兒科周邊靜脈留置針重新固定率，臨床發現孩童留置針常因靜脈輸液滴注不順暢而需拆開纏繞的膠帶並進行處理後再重新固定，處理過程耗時、耗力且常因此延誤常規給藥時間。確立問題為靜脈注射標準作業流程及靜脈留置針注射及固定正確性稽核表未依兒科專科性制訂、缺乏靜脈留置針衛教輔助工具、缺乏點滴bag加藥提示工具、固定板及保護物不適用、無攜帶式重新固定所需物品。小組成員運用創新擴散理論、腦力激盪，經由修訂標準作業流程與稽核表、製作輔助與提示工具、更換固定板與統一保護物、增設行動貼貼籃等解決策略，周邊靜脈留置針重新固定率由15.9%降至4.3%，達專案目的，經本專案改善後促進工作效率、減少醫療成本及提升照護品質。

The purpose of this project is to reduce the re-fixation rate of pediatric peripheral intravenous catheters. Clinically, it is found that the wrapping tape for children's peripheral intravenous catheters often needs to be disassembled and re-fixed after treatment due to the poor intravenous drip infusion. This process is time-consuming, labor intensive and often delays the routine treatment time. A project team was established to determine the major issues includes the standard operation procedure of intravenous injection and the correctness of the pediatric peripheral intravenous catheters injection as well as fixation checklist was not formulated according to the pediatric specialty; the lack of peripheral intravenous catheters nursing education aids, the lack of drip bag dosing tips, fixation plates and the protective equipment are not applicable, and there are no portable re-fixation of the required component. The team members utilize diffusion of innovations theory and brainstorming, through the revision of standard operating procedures and checklists; the production of auxiliary and prompting tools, replacement of fixed plates and unified protective equipment, and the incorporation of action stickers and baskets. The rate for re-fixation of peripheral intravenous catheters was reduced from 15.9% to 4.3% and had achieved the purpose of the project. After the enhancement of this project, work efficiency was stimulated, that reduces medical costs and improves the quality of care.

1. 胡靜文,陳鈴芳,林曉君,謝秀娟,鄧慶華(2018)。運用創新擴散理論提升疾病管理資訊系統使用率。護理雜誌，65(4)，109-116。
   連結：
2. Hetzler, R.,Wilson, M.,Hill, E. K.,Hollenback, C.(2011).Securing pediatric peripheral IV catheters -Application of an evidence-based practice model.Journal of Pediatric Nursing,26(2),143-148.
3. Hughes, F.(2006).Nurses at the forefront of innovation.International Nursing Review,53(2),94-101.
4. O’Grady、 N. P.,Alexander, M.,Burns, L. A.,Dellinger, E. P.,Garland, J.,Heard, S. O.,Lipsett, P. A.,Masur, H.,Mermel, L. A.,Pearson, M. L.,Raad, I. I.,Randolph, A. G.,Rupp, M. E.,Saint, S.,Healthcare Infection Control Practices Advisory Committee(2011).Guidelines for the prevention of intravascular catheter-related infections.Clinical InfectionDisease,52(9),162-193.
5. Platt, V.,Osenkarski, S.(2018).Improving vascular access outcomes and enhancing practice.Journal of Infusion Nursing,41(6),375-382.
6. Rogers, E. M.(2002).Diffusion of preventive innovations.Addictive Behaviors,27(6),989-993.
7. The Royal Children’s Hospital Melbourne. (2018, Apr, 20).Peripheral intravenous (IV) device management. Retrieved from https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Peripheral_Intravenous_IV_Device_Management/
8. 林嘉玲,王亞妮,蔡秀敏(2013)。創新思維在護理實務之運用。護理雜誌，60(2)，97-102。
9. 林品樺,張美玉,陳孟琪,張雲英,洪淑真(2015)。降低兒科病童週邊靜脈輸液導管阻塞率。榮總護理，32(1)，21-30。
10. 連心瑜,羅美芳,高碧霞(2014)。創新擴散理論之發展與護理應用。長庚護理，25(4)，404-412。
11. 溫玉燕,陳郁琪,李翠萍(2013)。降低某兒科病房非預期性靜脈注射重注率。馬偕護理雜誌，7(1)，41-51。
12. 衛生福利部（2018，4 月 12 日）．107-108 年度醫院醫療品質及病人安全工作目標(2018)．提升管路安全。http://www.patientsafety.mohw.gov.tw/Content/zMessagess/contents.aspx?&SiteID=1&MmmID=621273300317401756&MSID=777752343551741053.pdf[107-108 年度醫療品質及病人安全工作目標]