篇名 | 血液腫瘤病患人工血管照護品質改善專案 |
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卷期 | 58:3附冊 |
並列篇名 | Hematology-Oncology Port-A : Improving Nursing Care Quality |
作者 | 陳怡蓉 、 顏慶雲 |
頁次 | 064-072 |
關鍵字 | 照護品質 、 血液腫瘤 、 人工血管 、 血流感染 、 Nursing care quality 、 Hematology-oncology 、 Port-A 、 Bloodstream infections 、 MEDLINE 、 Scopus 、 TSCI |
出刊日期 | 201106 |
背景 : 血液腫瘤病患裝置人工血管以利化學治療,卻易血流感染影響預後。護理因其獨特地位得成為醫療團隊領導角色,藉由高品質護理、執行需要的改變,以預防人工血管血流感染並改善病人照護成效。2008年 7月至 2009年 6月,本單位發生 12件人工血管血流感染案例,感染率 3.18‰。經現況分析發現主要原因為: ⑴護理人員人工血管照護知能不足; ⑵人工血管護理技術標準及敷料更改; ⑶病患及家屬人工血管自我照護不足。因而成立專案小組進行改善。目的 : 本專案旨在提昇護理人員執行人工血管照護品質,以降低病患血流感染率。解決方案 : 於 2009年 8月 15日至 2009年 12月 20日執行改善策略,包含: ⑴修訂人工血管護理技術標準; ⑵更換敷料型號; ⑶執行不定期技術稽核; ⑷舉辦人工血管護理教育訓練; ⑸統一病患及家屬對人工血管的自我照護指導標準。 結果 : 血液腫瘤病患人工血管血流感染率由 3.18‰降至 0.99‰,下降率 68.87%。 結論 : 本專案有效降低人工血管血流感染率、提升病患安全及臨床照護品質,可作為同儕單位照護血液腫瘤病患之參酌。
Background: Hospitalized hematology-oncology patients undergoing chemotherapy face a significant risk of port-Arelated bloodstream infections. Nurses are uniquely positioned to help adjust clinical practices necessary to prevent port-A related bloodstream infections and improve patient outcomes. Between July 1st, 2008 and June 30th, 2009, twelve patients in our ward were stricken with port-A related bloodstream infections (an infection rate of 3.18‰). Data analysis indicated inadequate nursing competency in all aspects of port-A care. Nurses did not have adequate knowledge of port-A modified standard care protocols and did not provide dressings suited to hematology-oncology patient needs. Also, both patients and caregivers lacked adequate skin care knowledge. Our team developed a project to address and minimize port-A related bloodstream infection issues in our hospital.Objects: The authors designed this project to enhance integration of both the central line insertion care and maintenance practice bundles in order to reduce port-A related bloodstream infection incidence.Resolution: The plan was implemented from August 15, 2009 to December 20, 2009. It included establishing a standardization port-A care protocol, implementing a more appropriate dressing type, performing an irregular audit of port-A care techniques, holding educational training, and establishing skin care instructions for patients and their families.Results: Hematology-oncology patient port-A related bloodstream infections fell from 3.18‰ pre-implementation to 0.99‰ post-implementation. The effective rate of improvement was 68.87%.Conclusion: Standardization of Port-A care under this project achieved infection reduction results that achieved our anticipated goals. This project furthermore enhanced the delivery and quality of patient nursing services. This experience can serve as a reference to medical organizations involved in hematology-oncology patient care.