提升燒傷加護病房護理人員照護重度燒傷病人輸液復甦評估能力專案

Project to improve burn nursing staff's ability of fluid resuscitation on severe burn patients

林翠姬(Tsui-Chi-Lin) ； 粘惠先(Hui-Hsien Nien) ； 楊慧文(Hui-Wen Yang) ； 林采蓉(Tsai-Rung Lin)

《高雄護理雜誌》 34卷2期 (2017/08) Pp. 52-62

https://doi.org/10.6692/KJN-2017-34-2-5

摘要

燒傷病人急性期照護首重輸液復甦，若護理人員輸液復甦評估能力不足，恐造成燒傷病人輸液復甦相關併發症發生。本單位2014年重度燒傷病人因輸液復甦產生併發症者發生率為41.6%，於2015年4月22日至25日評核護理人員執行輸液復甦評估能力，平均正確率僅達52.3%，故引發專案小組的動機。經分析發現主要問題為輸液復甦評估技巧來自學姐口耳相傳、未能實際演練及回覆示教、未舉辦輸液復甦相關在職教育、缺乏評估的準則及未定期稽核評估能力；目標為護理人員執行重度燒傷病人輸液復甦評估能力由52.3%提升至90%以上，決議方案:舉辦床邊教學、教育課程及錄製評估示範影片、以模擬情境方式策劃評估技能課程、制定評估標準及監測計劃。專案執行後，評估能力正確率提升至97%，後續追蹤併發症發生率為11.1%。本專案措施確實可提升執行重度燒傷病人輸液復甦評估能力正確率，進而降低併發症發生率。

關鍵字

重度燒傷 ； 護理人員 ； 輸液復甦評估能力

並列摘要

Evaluating the fluid resuscitation recovery is indispensable in acute stage care among burn patients. In 2014, the incidence rate of complication related to insufficient fluid resuscitation evaluation was 41.6%. The accuracy rate of nursing staff’s ability in fluid resuscitation evaluation was approximately 52.3% between April 22nd and 25th in 2015. Word of mouth from senior colleagues, lack of clinical practice and teaching, lack of in-service education, lack of evaluation rules or audit capability might be the main reasons for this issue. The project purpose was to improve the accuracy rate of nurse staff’s knowledge on fluid resuscitation evaluation in severe burn patients from 52.3% to over 90%. Interventions included (1) arrangement of a bed-side teaching program, (2) recording of a demo video in fluid resuscitation, (3) simulation of the clinical situation to evaluate the ability, and (4) establishment of an evaluation standard and audit plan during the period between May to September in 2015. After 4 months of intervention practice, the accuracy rate in evaluation ability consequently improved to 97%. The incidence rate of fluid resuscitation complication decreased to 11.1%. The project not only improved the accuracy in fluid resuscitation among severe burn patients, but also decreased the incidence rate of complications related to inappropriate fluid resuscitation evaluation.

並列關鍵字

severe burn ； nursing staff ； fluid resuscitation evaluation

參考文獻

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羅淑芬（2015）･嚴重燒傷病人護理處置･護理雜誌，62（4），82-88。

Azzopardi, E. A., McWilliams, B., Iyer, S., & Whitaker, I. S. (2009).Fluid resuscitation in adults with severe burns at risk of secondary abdominal compartment syndrome--an evidence based systematic review. Burns, 35(7), 911-920. doi: 10.1016/j.burns.2009.03.001S0305-4179(09)00079-5

Cancio, L. C. (2014). Initial assessment and fluid resuscitation of burn patients. Surgical Clinics of North America, 94(4), 741-754. doi: 10.1016/j.suc.2014.05.003S0039-6109(14)00066-8

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