運用團隊資源管理降低加護病房導尿管使用率

背景：文獻指出加護病房住院病人中74%-84%曾使用過導尿管，醫療健康照護感染以泌尿道感染居多，且與導尿管使用密切相關，嚴重可能導致菌血症，使死亡率提高。本單位年平均導尿管使用率78.7%，高於院內其他內科系加護病房，考量導尿管置放、移除與照護，需仰賴跨團隊合作完成，故需運用團隊資源管理（team resource management）概念進行專案改善。目的：降低加護病房導尿管使用率至69.3%以下。解決方案：2017/1/3調查單位導尿管使用率高之原因，並於2017/2/1至2017/6/30提出並進行改善措施，包含：推動留置導尿管提醒標示、以超音波膀胱容量掃描儀代替間歇性導尿、協助執行留置導尿管評估單及移除導尿管後流程、過程中每週定期舉辦跨團隊會議，共同討論解決方案、當月份30日評值結果並執行獎勵制度。結果：2017/3/1至2017/6/30單位平均導尿管使用率由改善前78.7%降至57.8%，改善幅度為26.5%。結論：專案推行後不僅有效減少非必要導尿管使用，並強化團隊合作精神，提升醫療照護品質。

關鍵字

導尿管移除流程；間歇性導尿；跨團隊合作；超音波膀胱測定儀；泌尿道感染

並列摘要

Background & Problems: According to the literature, 74%-84% of patients in adult critical care units have an indwelling catheter. The majority of medical and healthcare infections are urinary tract infections, which are related to urinary catheter usage. Furthermore, critical infections may cause bacteremia, which increases the risk of mortality. Prior to this project, over three-quarters (78.7%) of patients in our unit used a urinary catheter, which is a rate that is higher than all other intensive care units of our hospital's internal medicine department. Due to Foley placement, removal and care of catheters requires collaboration of teamwork. Thus, the concept of team resource management may be applied to improve the situation. Purpose: The aim of this study was to reduce the urinary catheter usage rate in our intensive care unit to less than 69.3%. Resolutions: This project summarized the reasons for the high catheter usage rate in this unit on 2017/1/3 and implemented several approaches to improve the situation from 2017/2/1 to 2017/6/30. These approaches included affixing reminder labels to indwelling catheters, using an ultrasound bladder scanner as a substitute for intermittent catheterization, evaluating indwelling catheters, establishing flow planning for post-catheter removal, holding cross-team meetings, and adopting a reward system. During the improvement period, we held collaborative conference meetings weekly to discuss solutions, evaluate end-of-the-month progress, and set reward policies. Results: We lowered the average urinary catheter usage rate from 78.7% on 2017/3/1 to 57.8% on 2017/6/30, achieving a 26.5% reduction in catheter usage. Conclusions: This project both effectively reduced the unnecessary use of urinary catheters and significantly strengthened team spirit in our unit, thus improving the quality of medical care provided.

並列關鍵字

urinary catheter removal process ； intermittent catheterization ； interdisciplinary collaboration ； ultrasound bladder scanner ； urinary tract infection

參考文獻

王佩琮、林湘玉、林意純、辛文蕙、簡莉盈、林小玲（2017）．依適應症提示移除尿管可降低內科病房導尿管相關尿路感染．護理雜誌，64（1），70–79。[Wang, P. T., Lin, H. Y., Lin, Y. T., Shin, W. H., Chien, L. Y., & Lin, S. (2017). Using an indicator-based reminder of catheter removal to effectively decrease catheter-associated urinary tract infections in general medical patients. The Journal of Nursing, 64(1), 70–79.] https://doi.org/10.6224/JN.00010

白玉珠、江琳瑩、葉純宜、陳美娟、童惠芳、柯秀錦（2013）．移除導尿管時機對病人感受、重插率及泌尿道感染之影響．護理暨健康照護研究，9（1），33–41。[Pai, Y. C., Chiang, L. Y., Yeh, C. Y., Chen, M. C., Tung, H. F., & Ke, X. J. (2013). A comparison of the effects of night and day removal of urinary catheters on patient perceptions, re-catheterization rates and urinary tract infections. Journal of Nursing and Healthcare Research, 9(1), 33–41.] https://doi.org/10.6225/JNHR.09.1.33

江惠英（2015）．再談團隊資源管理．領導護理，16（4），2–10。[Chiang, H. Y. (2015). A reflection of team resource management. Leadership Nursing, 16(4), 2–10.] https://doi.org/10.29494/LN.201512_16(4).0001

林蔚如、洪靖慈、鄭宇辰、陳彥旭、盧柏樑（2017）．預防導尿管相關泌尿道感染組合式照護．內科學誌，28（1），12–17。[Lin, W. R., Hung, C. T., Cheng, Y. C., Chen, Y. H., & Lu, P. L. (2017). Catheter-associated urinary tract infections and care bundle. Journal of Internal Medicine of Taiwan, 28(1), 12–17.] https://doi.org/10.6314/JIMT.2017.28(1).03

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。[Chi, M. M., & Chen, Y. Y. (2013). Effectiveness of guidelines for removal of indwelling urinary catheter to reduce urinary tract infections. Formosan Journal of Medicine, 17(3), 238–245.] https://doi.org/10.6320/FJM.2013.17(3).02

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運用團隊資源管理降低加護病房導尿管使用率

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