本單位為創傷神經外科加護病房，病人術後常有腦室外引流裝置，曾發生引流裝置阻塞及脫落導致無法監測顱內壓，而嚴重影響病人的治療計畫及安全，顧引發動機改善問題。於2011年8月12日經由規劃「新進護理人員腦室外引流裝置護理及顱內壓測量法之訓練流程圖」，由固定護理臨床教師運用教學光碟配合雷射水平儀的使用指導護理人員，經6個月專案改善後，「腦室外引流裝置護理知識測驗」完整率由33.0%提升為85.4%，「腦室外引流裝置護理及湖內壓測量法」由55%提升為91.0%，且直到2012年7月31日未再發生病人腦室外引流裝置阻塞或滑脫等意外事件，提升護理人員的照顧品質，借此分享經驗

The unit as a neurosurgical intensive care unit, post-operative external ventricular drainage (EVD) occurred the obstructions and shedding, unable to monitor intracranial pressure, seriously affecting patient safety. We found nurses care that insufficient knowledge and measurement methods are inconsistent, so planning “The flowchart for training new nurses of external ventricular drainage care and the intracranial pressure measurement”. The nursing preceptor used of the teaching CD and laser level. A project improved the “nursing knowledge examination for external ventricular drainage” increase the completeness rate from 33.0% to 85.4%, “measurement methods by intracranial pressure” from 55% to 91% .Until now no occurrence of patient ventricular drainage device blocked or slippage and other accidents. Proposing this experiences for improve the quality of nursing care.