提升使用ECMO病人轉送檢查前置準備完整性

An Improvement Project for Preprocessing Completeness Before Transferring Patients Using Extra Corporeal Membrane Oxygenation

楊斐茹(Fei-Ju Yang)；吳雅慧(Ya-Hui Wu)；黃慧玲(Hui-Ling Huang)；陳春香(Chun-Hsiang Chen)；湯婉孏(Wan-Lan Tang)

體外維生系統 ； 加護病房 ； 轉送 ； extracorporeal membrane oxygenation (ECMO) ； intensive care unit ； transfer

志為護理-慈濟護理雜誌

21卷2期（2022 / 04 / 01）

63 - 75

繁體中文

本專案旨在提升使用體外膜氧合系統（Extra-Corporeal Membrane Oxygenation, ECMO）病人轉送檢查前置準備完整性，動機係由前置準備缺失如：移床時導管滑脫、未注意藥物量不足、氧氣量不足等因素，可能瞬間影響病人安全而引發。分析原因為經驗不足佔37%、專訓課程資訊少、依師徒傳承經驗，無一致做法及順序、儀器多導致推床擺放空間不足等。經制定N1、N2專科訓練、檢查前置準備流程、規劃實務演練、製作儀器架等措施後，護理人員在使用ECMO病人轉送檢查前置準備完整性由64%提升至100%、認知正確率由79%提升至98%，藉此經驗可提供照護參考，達到醫療品質及病人轉送安全之目的。

This study aimed to increase the preprocessing completeness before transferring patients using extracorporeal membrane oxygenation (ECMO). The motive is driven by defects of preprocessing before transferring the patients, which includes accidental central venous catheter removal when moving the patient from bed to bed, as well as other human factors that may jeopardize patients' safety like failing to pay attention to insufficient dose of medication and oxygen. After analysis of the cause, the defects were found to occur due to the employee's lack of experience (contribute to 37%), insufficient information regarding professional training courses, employee's conduction based on the seniors' experience, lack of inconsistent procedures and orders to operate the transfer, insufficient space for simple manual hospital bed because of too many important equipment, etc. The procedure was laid out for patients using ECMO for examination and practical operation, and a shelf was made for placing the equipment when transferring. The resulting completeness of preprocessing procedure before transferring had increased from 64% to 100%, while the correctness rate of the preprocessing procedure before transferring the patients using ECMO had increased from 79.1% to 98%. The experience can be a reference for nursing care, medical quality assurance, and patient's safety.

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