- 期刊
運用多元方案及情境參與式衛教降低非計畫性Port-A角針滑脫率
Using a Diversity of Programs and Participants Education to Reduce the Incidence Rate of Port-A Cath Slippage
摘要
背景：癌症病人經常使用靜脈內植式人工血管（Port-A Catheter, Port-A）作為頻繁接受靜脈化學治療的給藥途徑，避免長期反覆的靜脈注射造成周邊血管受刺激而硬化或壞死。Port-A角針滑脫事件，可能造成化療藥物外滲導致組織壞死的傷害、增加住院日數及醫療成本等。2020年度統計本單位病安事件中Port-A角針滑脫率為0.60%，Port-A管路照護完整率為85%未達閾值。本專案運用多元方案及參與式衛教，為提升護理人員Port-A管路照護品質，增進病人及照顧者對Port-A管路照護的認知，最終達到降低Port-A角針滑脫率的目的。解決方案：重新審閱並修訂Port-A管路照護標準作業，提出「氣密窗型貼固定法」改良方案、舉辦Port-A管路照護擬真教學、拍攝Port-A管路照護多媒體衛教影片、設立QR-code及衛教影片觀賞區、製作Port-A管路照護衛教單張及圖卡，統一並落實衛教指導標準。結果：Port-A角針平均滑脫率由改善前0.60%下降至0.17%；監測Port-A管路照護完整率85%上升至98%，效果維持為100%；預防Port-A角針滑脫衛教滿意度平均達92%。結論：專案主旨在降低Port-A角針滑脫率，一併改善Port-A管路照護完整率，運用情境參與式衛教強化護理指導成效，同時降低管路滑脫意外，保障病人就醫安全，使其享有高品質醫療照護。
並列摘要
Backgrounds: Port-A catheters (hereafter Port-A) have frequently been employed to administer intravenous chemotherapy to patients diagnosed with cancer to prevent arteriosclerosis or vascular necrosis caused by long-term repeated intravenous injection. Port-A needle slippage can cause chemotherapy drug extravasation, leading to tissue necrosis, prolonged hospitalization, and increased medical cost. According to the 2020 statistical report on the patient safety incidents in our unit, the rate of Port-A needle slip was 0.60%; and the completion rate of Port-A catheter care was 85%, which did not meet the threshold. This study employed various programs and participatory health education to improve the quality of Port-A catheter care and the knowledge of patients' families on Port-A, thereby reducing the rate of Port-A needle dislodgement and related complications. Solution: Review and revise the Port-A catheter care standard operating procedures, propose the airtight window sticker fixing method, conduct immersive teaching of Port-A catheter care, record a multimedia health education video on Port-A catheter care, set up a viewing zone or QR-code for the video access, create health education leaflets and picture cards on Port-A catheter care, and enforce the unified health education guidelines. Results: The average rate of Port-A needle slip decreased from 0.60% to 0.17%; the completion rate of monitored catheter rose from 85% to 98%, with the effectiveness maintained at 100%; the average satisfaction toward the health education on preventing needle slip was 92%. Conclusion: The goal of this study was to reduce the rate of Port-A needle slippage and improve the completion rate of Port-A catheter care. Through the reinforcement of the nursing guidance by situational and participatory health education, the rate of needle slippage accidents decreased, safeguarding patient safety and the quality of care.