癌症病房週邊植入中心靜脈導管（PICC）置放之流程再造改善專案

The Process Reengineering of PICC Insertion in Cancer Ward

陳君嫚(Chun-Man Chen)；趙淑貞(Chao-Shu Chen)；張信慧(Hsin-Hui Chang)；張文震(Wen-Chen Chang)；王昭慧(Chao-Hui Wang)

週邊植入中心靜脈導管 ； 流程再造 ； 化學治療 ； PICC ； process reengineering ； chemotherapy

若瑟醫護雜誌

7卷1期（2013 / 08 / 01）

59 - 70

繁體中文

週邊植入中心靜脈導管（Peripherally Inserted Central Venous Catheter；簡稱PICC），是一種人工血管，因置放及移除程序安全簡單，廣泛使用於中長期進行化學治療之病人。臨床發現因PICC置放流程繁複，造成病人等待置放時間過長，增加病人的焦慮及抱怨，因而引發改善動機。故本專案目的在改善週邊植入中心靜脈導管置放流程，以縮短病人等待時間及提昇滿意度。經現況調查發現平均每位病人等待置放PICC時間高達2938.3分鐘，整體滿意度僅達3.0（5分法），分析其原因，為作業流程繁複、等候時間過長、執行前缺乏完整說明、未提供傷口護理衛教手冊等。經重新設計流程，簡化參與人員，組成PICC置放小組執行PICC置放及執行護理指導、設立PICC置放衛教手冊等，改善措施實施後，評值置放PICC病人等待時間縮短為69.9分鐘，其滿意度提昇到4.8（5分法），顯示本專案能有提昇PICC置放時效性及提昇病人滿意度。

Peripherally Inserted Central Venous Catheter (PICC) is a kind of artificial vascular devices which has lower risk of complication and is easy for insertion, removal and maintenance. PICC is now widely used as long-term venous access device in cancer patients under chemotherapy. However, the scheduling for PICC insertion seems time-consuming in clinical practice which results in the anxiety and fright in cancer patients. Therefore, the aim for the project is to improve the process of PICC insertion, shorten the waiting time and the satisfaction of cancer patients.After data analysis, we found that a relative large portion of cancer patients were not satisfied with the process of PICC insertion. The possible etiologies were lack of detail description about the whole procedure, waiting too long, no provide of patient handouts about wound care information, too complex process and too many participants involving in this process. We improved the PICC insertion process by recruitment of trained nurse practitioner, establishment of PICC procedure educational handouts, to simplify the participants and re-design the flow path in this procedure. We shortened the average waiting time from 2938.3 minutes to 69.9 minutes. The level of flow path satisfaction also upgraded form 3.0 to 4.8 (by five-point method). Our project efficiently promotes the timelines of PICC insertion and patient satisfaction.