運用跨領域團隊模式降低神經外科病房泌尿道感染率

Apply Team Resource Management for Urinary tract infection rate in Neurosurgery Wards

10.6647/CN.201806_25(2).0004

張淑媛(Shu-yuan Zhang)；魏素敏(Su-min Wei)；陳佩娟(Pei-chuan Chen)；林金蘭(Chin-Lan Lin)；廖惠娟(Hui -chuan Liao)

泌尿道感染 ； 團隊資源管理 ； Urinary tract infection ； team resource management

彰化護理

25卷2期（2018 / 06 / 01）

9 - 20

繁體中文

「泌尿道感染」造成病人傷害增加醫療支出是可預期的，本院神經外科病房尿道感染率居全院之冠，院方建議神經外科照護團隊以「團隊資源管理」手法進行預防泌尿道感染專案改善，經現況分析確認原因：(1)未依標準步驟執行導尿管置入與照護、(2)缺乏教育訓練、(3)未參與尿管組合式照護、(4)無提示尿管移除規範、(5)照護衛教指導不確實、(6)病床太低導尿管落地。為達專案目的經實施對策：(1)修訂拍攝導尿管置入教學影帶。(2)舉辦在職教育訓練。(3)參與導尿管組合式照護規範。(4)電腦系統增設導尿管留置提醒視窗。(5)製作並推行導尿管留置注意事項衛教單張，懸掛於床尾。(6)增設改善尿袋不落地設備後。泌尿道感染率由平均千分之2.6下降至千分之1.21，達到專案目的，並提升管路照護品質的完整性。

IUrinary tract infection (UTI) may cause additional patient injuries and leads to increased medical expenditures. In our hospital, the UTI incidence rate in Neurosurgery ward was the highest among all wards, with the injuries caused by Urinary tract infection becoming increasingly severe. The hospital suggested that the Neurosurgery team to develop a project aiming at preventing UTI by using ＂Team Resource Management＂. After analyzing the Neurosurgery ward current situation, the causes of UTI were confirmed: (1) foley catheterization and care did not follow standard operating procedures, (2) lack of continuous education and training, (3) not attached with foley bundle care, (4) lack of catheter removal, (5) care education is inaccurate, (6) The bed is too low so that catheters touched the ground. To achieve this improving project goal, strategies developed for preventing the incidences of UTI are listed as followed: (1) to revised and film the catheterization process into education video, (2) to hold continuous education program, (3) to apply foley bundle care,(4) to add foley catheterization reminder window in computer system, (5) to develop foley catheter caring notifications and education leaflets which could be hanging on the end of beds, (6) to add equipment to avoid urine bag from approaching the ground. After applying this improving project, UTI incidences decreased from 2.6 per mille to 1.21 per mille; this result indicates that not only the goal of reducing UTI incidences was achieved, but also the complete rates and quality of catheter care were promoted.

1. Hooton, T. M.,Bradley, S. F.,Cardenas, D. D.,Colgan, R.,Geerlings, S.E.,Rice, J.C.(2010).Diagnosis, prevention, and treatment of catheter associated urinary tract infection in adult: 2009 international clinical practice guidelines from the infectious diseases society of America.Clinical Infectious Diseases,50(5),625-663.
2. Interprofessional Education Collaborative Expert Panel(2011).Core competencies for interprofessional collaborative practice: Report of an expert panel.Washington, DC:Interprofessional Education Collaborative.
3. Shea-Lewis, Anne(2009).Teamwork: crew resource management in a community hospital.Journal for Healthcare Quality,31(5),14-18.
4. Trautner, B. W.(2010).Management of catheter-associated urinary tract infection.Current Opinion in Infectious Diseases,23(1),76-82.
5. 李允吉,劉建衛(2010)。導尿管相關的菌尿和尿路感染。感染控制雜誌，20(3)，163-172。
6. 林志彦,翁珮瑄,柯蘋芯,許振榮,王惠珺,余書蓉(2013)。復健病房腦中風病人泌尿道感染之危險因子。醫學與健康期刊，2(1)，39-47。
7. 林佳慧,陳玉如,蔣立琦(2013)。應用跨專業領域團隊之實證醫療促進臨床病人安全及照護品質。榮總護理，30(2)，121-129。
8. 林瑛釗(2011)。中風病人預防泌尿道感染之探討。領導護理，12(2)，112-120。
9. 林詩淳,徐明洲,蔡坤維(2010)。老年常見之泌尿道感染。志為護理雜誌，9(5)，66-70。
10. 洪淑貞,酆玲玲,林淑卿,劉彩娥,劉惠瑚(2013)。降低呼吸照護病房病患之泌尿道感染密度。醫學與健康期刊，2(1)，89-99。
11. 紀美滿,陳瑛瑛(2013)。應用「導尿管移除評估指標」對降低泌尿道感染之成效。台灣醫學，17(3)，238-245。
12. 陳志金(2012,11月),醫療團隊資源管理技巧複習與實務運作導入。取自www1.cgmh.org.tw/intr/intr4/c8220/chinese/trm/2.pdf
13. 黃政華、李聰明(2012).泌尿道感染之預防介入措施,民104年10月13日。取至: http://www.tma.tw/se_dis/50.asp
14. 黃萬翠,王復德,陳瑛瑛,孫淑美(2014)。應用電腦提醒拔除導尿管機制對導尿管使用及尿路感染之影響。護理暨健康照護研究，10(1)，70-77。
15. 甄嫻,林玉娟,洪美玲(2010)。内科加護病房泌尿道感染率改善專案。安泰醫護雜誌，16(1)，15-28。
16. 劉越萍(2009)。利用醫療團隊訓練以促進病人安全。醫療品質雜誌，3(1)，68-72。
17. 蔡如怡,葉樹人(2011)。醫療團隊合作─團隊溝通的模式與技巧。亞東醫院品質季刊，3(3)，10-13。