提升護理人員周邊置入中心靜脈導管照護正確率之專案

A Project of Elevating the Accuracy Rate of Peripherally Inserted Central Catheter (PICC) Implementation for Nurses

陳儷月(Li-Yueh Chen) ； 張麗君(Li-Chun Chang) ； 阮呂文貞(Wen Chen Juan-Lu)

《腫瘤護理雜誌》 20卷1期 (2020/06) Pp. 33-49

https://doi.org/10.6880/TJON.202006_20(1).03

摘要

周邊置入中心靜脈導管（peripherally inserted central catheter, PICC）是一種安全性高的靜脈輸液管路，並可避免因藥物外漏造成組織壞死的人工血管。本單位未曾照護放置PICC管路的病人，故單位護理師對於導管照護認知及操作皆不正確，經專案小組調查發現護理師照護認知正確率48.7%及執行正確率58.3%，故引發改善動機。專案目的設定為：1.提升護理師PICC照護認知率達95%、2.PICC執行正確率達92%。專案小組藉由特性要因圖，整理照護PICC知能較低的因素，再利用真因驗證查檢表分析主要導因為：缺乏PICC標準作業規範、採取口述教導、缺乏教學工具、缺乏PICC照護教育訓練等。專案進行改善對策包含制定PICC照護標準作業程序、規劃擬真訓練、建立PICC教育訓練機制、建置PICC護理衛教單、錄製PICC照護影片、建立PICC照護多媒體資訊等，經實施專案後，認知率提升為98.3%、運用擬真情境監測全體護理師執行正確率為95.6%，而以臨床實際查核照護正確率達95.0%，達專案設定目標。本專案特色乃運用模擬教學方式，設立PICC照護標準程序及教案，不僅提升護理師的照護知能，更促進病人的就醫安全。

關鍵字

周邊置入中心靜脈導管 ； PICC導管照護 ； 擬真教學

並列摘要

The peripherally inserted central catheter (PICC) has become one of the most common central venous access tools for the patients with chemotherapy or long-term intravenous therapy in many general wards. PICC is a considerably safe intravenous infusion catheter which could avoid tissue necrosis caused by drug leakage in an artificial blood vessel. The investigated ward has never had patients using PICC in treatments. Consequently, the nursing staff in said ward are relatively incompetent in the area of catheter care, which motivated the author to want to build such abilities in the staff. The aim of this study is to improve the awareness of PICC function and use in nursing care. The survey before intervention found that the awareness in nurses was only 48.7%, and the correct rate of operating skills was under 58.3%. Based on the results of circumstances analysis in consort with literature review, the problems were classified as 1. No PICC standard operating instructions were established, 2. Teaching was done only in a narrative setting, 3. Lack of teaching equipment, 4. Shortage of education and training of PICC care, 5. Insufficient nursing experience, and 6. No guideline material of PICC has been established et al. The improvement project includes 1. Developing PICC care standard operating procedures, 2. Planning of high-fidelity patient simulation teaching and training methods, 3. Forming a mechanism for PICC education and training, 4. Establishing a brochure for PICC nursing education, 5. Production of PICC care procedure video, and 6. Use of the multimedia information system for PICC care, et al. The results showed the percentage of nurses' awareness and operating skills accuracy rate reached 98.3% and 95.0%, respectively. This study is characterized by using high fidelity patient simulation teaching methods, the establishment of PICC care standard procedures and lesson plans. It not only could enhance the quality of care and knowledge of the nurses but also improve and promote quality of life and patient safety.

並列關鍵字

PICC care ； cancer patient ； fidelity patient simulation teaching

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