運用模擬教學改善中心導管組合式照護正確率

Improving the Accuracy Rate of Central Venous Catheterization Care Bundle：An Application of Simulation Teaching

10.6692/KJN.201812_35(3).0005

黃靜敏(Ching-Min Huang)；王淑娟(Shu-Chuan Wang)；蔡曉雯(Hsiao-Wen Tsai)；蘇佩真(Pei-Chen Su)

中心導管 ； 組合式照護 ； Central line ； care bundle

高雄護理雜誌

35卷3期（2018 / 12 / 01）

48 - 60

繁體中文

重症病人發生血流感染會使死亡率大幅提升。本院加護病房2013年中心導管相關血流感染密度為千分之1.96，發生中心導管血流感染，造成對病患的安全是一大威脅，因此引發專案小組動機。本專案旨在提升醫護人員中心導管照護正確率，以降低中心導管相關血流感染。專案小組討論及文獻查證後，設立相關改善策略：一、重建中心導管照護作業規範及品質管理監測；二、舉辦教育訓練；三、設置中心導管專用包布；四、設置中心導管專用工作車；五、設計創意文宣及病人發言板；六、訂定獎勵制度。結果顯示專案介入後醫護人員執行中心導管照護正確率皆大於95%及中心導管血流感染密度下降至千分之0.4，感染率雖未達千分之0，但繼續以零感染為目標改進。期望藉由模擬教學及實質獎勵制度提升醫護人員配合度、增強重症照護品質，降低感染率進而減少醫療成本。

For critical patients, bloodstream infections result in a higher rate of mortality. In 2013, the infection density of central line-associated bloodstream (CLABSI) was 1.96 per mille in the intensive care unit of a regional hospital. When a CLABSI occurs, it is a threat to the safety of patients. The purpose of the project aimed to improve the accuracy rate of central line care to reduce central line-associated bloodstream infections. Based on a literature review and discussion meetings, several strategies were proposed by the project teammates, which included (1) resetting the nursing standards of central line care and improving the nursing quality monitoring program; (2) conducting educational training; (3) providing the package of central line; (4) offering a nursing cart for the central line; (5) designing creative leaflets and boards of patients opinions and (6) creating a reward system. The result indicated that the accuracy rate improved to over 95%with the help of central line care by medical staff and the infection density of CLABSI decreased to 0.4 per mille. Although it was not 0 per mille, it will continue to improve with zero tolerance as our goal. It was expected that the simulation training and the reward system could enhance the compliance of medical staff, improve the quality of critical care, reduce the infection rate, and cut down on medical cost.