提升門診化學治療中心護理師執行跨院際拔針衛教指導完整性之專案改善

Improving the Integrity of Guidelines for Inter-hospital Health Education on Needle Withdrawal for Outpatient Chemotherapy Nurse Practitioners

10.6880/TJON.202006_20(1).02

洪千惟(Chien-Wei Hung)；何倩宜(Chien-Yi Ho)；李貞誼(Chen-Yi Li)；鄭惠蘭(Hui-Lan Cheng)

跨院際 ； 拔針 ； 居家化療 ； inter-hospital ； needle withdrawal service ； home-based chemotherapy

腫瘤護理雜誌

20卷1期（2020 / 06 / 01）

19 - 31

繁體中文

本專案目的為改善門診化療護理師執行居家化療跨院際拔針衛教指導完整率，據統計，本院執行居家化療的病人有83.3%願意至居家附近的醫療院所移除針頭，顯示病人於鄰近醫院拔針意願高，但實際至外院移除針頭的比率僅佔2.4%。分析原因為：1.護理師缺乏跨院際拔針院所相關資訊、2.護理師無跨院際拔針標準流程可依循、3.化療注射單書寫內容未整合、4.注射單無固定擺放位置。專案小組成員透過改善方法：1.制定外院拔針標準化作業流程，2.收集北、中、南地區可提供拔針服務之醫療院所，並制定拔針資訊及流程，3.統一注射單書寫格式，4.規劃收納櫃擺放注射單並清楚標示拔針日期，實施後門診化療護理師執行居家化療外院拔針衛教指導完整率提升為85%。每月執行外院拔針由2.4%增加為13.8%，對居家化療執行外院拔針實際執行率有顯著成效。

The purpose of this project is to improve the guideline integrity rate of health education on the inter-hospital needle withdrawal for outpatient chemotherapy nurse practitioners of home-based chemotherapy. The statistics showed that 83.3% of patients receiving home-based chemotherapy in our hospital are willing to have the needle removed at their neighborhood hospitals, indicating a high intention, but the actual rate of needle withdrawal at other hospitals is only 2.4%. The reasons after analysis are: (1) nurse practitioners have insufficient information in inter-hospital needle withdrawal; (2) no inter-hospital needle withdrawal standard procedure to follow; (3) incomprehensive written content of chemotherapy injection sheet; and (4) no designated location for placement of injection sheet. The project team members proposed the following improvement approaches: (1) to establish standardized operating procedures for needle withdrawal in other hospitals; (2) to identify the medical institutions in the north, central, and south area that can provide needle withdrawal services, and develop protocol and procedures for needle withdrawal; (3) to standardize the format of written injection sheet; and (4) to plan a storage cabinet to place the injection sheet with the date of the needle withdrawal clearly indicated. After implementation of these measures, the integrity rate of health education guideline for the outpatient chemotherapy nurse practitioners on needle withdrawal for home-based chemotherapy at other hospitals increased to 85%. The actual rate of needle withdrawal at outside hospitals increased from 2.4% to 13.8% per month showing signaling remarkable effects. This lifted the burdens of travelling to and from the hospital for the patients receiving home-based chemotherapy.

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