提升兒童加護病房中心導管組合式照護完整率

Improving the Integrity Rate of Central Venous Catheter Bundle Care in Pediatric Intensive Care Unit

莊舜惟(Shun-Wei Chuang)；翁于涵(Yu-Han Weng)；邱瑞緣(Jui-Yuan Chiu)；陳瑾芬(Jin-Fen Chen)；李秀芳(Hsiu-Fang Lee)

兒童 ； 中心靜脈導管 ； 組合式照護 ； bundle care ； central venous catheter ； pediatric

志為護理-慈濟護理雜誌

22卷5期（2023 / 10 / 01）

81 - 93

繁體中文;英文

背景：兒童因年齡、疾病因素，加上血管細小，頻繁的周邊血管穿刺更增加兒童焦慮恐懼，故在兒童重症醫療中，中心導管是不可缺少的一部份，2020年1-4月本單位CLABSI平均為8.7，高於院內閾值4，更高於衛福部統計值4.3，而CLABSI與預防CLABSI之中心導管組合式照護完整率有關，故成立專案改善小組。目的：透過專案的進行，提升兒童加護病房中心導管組合式照護完整率，進一步降低並控制CLABSI。解決方案：藉由認知、情意、技能三大範疇的概念延伸優化組合式照護措施，運用課室教學搭配E化措施進行人員教育、物料與環境可近性、可用性的提升、建立稽核機制維持組合式照護品質的穩定。結果：中心導管組合式照護完整率達標100%、照護認知正確率84.3%提升至98.3%、CLABSI由8.7降至3.8。結論：期望專案中心導管組合式照護完整率大幅提升、CLABSI的下降，這樣顯著的進步能帶給同仁實質成就感與自信，更增進工作默契及團隊向心力，凝聚團隊往血流感染零容忍目標邁進。

From January to April 2020, the average rate of central line-associated bloodstream infections (CLABSI) in the pediatric intensive care unit was 8.7%, which was higher than the standard threshold of 4% in the hospital. A clinical survey found that the completion rate of the central venous catheter care bundle was only 77%. Therefore, this project aimed to improve the completion rate of central catheter combined care. The main reasons for the low completion rate include: insufficient awareness of central catheter combined care; insufficient accessibility and availability of catheter placement-related materials; and lack of audit for central venous catheter care bundle. During the project period from June 2020 to January 2021, intervention focused on the three major areas of cognition, affect and skills as the core, combined with E-oriented education, planning on-the-job education, setting up catheter disinfection boxes and exclusive vehicles, and establishing an audit system. The intervention resulted in the completion rate of central catheter combined care reaching 100%, the correct rate of nursing cognition increased from 84.3% to 98.3%, and the CLABSI decreased from 8.7% to 3.8%. In addition to improve the quality of care and infection control, the project united the medical team and promoted work efficiency.

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