運用團隊資源管理降低外科加護病房非計劃性中心靜脈導管滑脫率之專案

Applying Team Resource Management to Reduce the Unplanned Removal Rate of Central Venous Catheter in Surgery Intensive Care Unit

施孟綾(Meng-Ling Shih) ； 陳慧菁(Hui-Ching Chen) ； 廖玉美(Yu-Mei Liao)

《嘉基護理》 16卷2期 (2016/12) Pp. 10-20

摘要

背景：中心靜脈導管滑脫可能造成病人的生命徵象不穩、重新置入管路、增加住院日數及醫療成本，甚至死亡等極重度傷害。因此，護理人員正確評估管路狀況及執行管路照護標準，能減少管路滑脫，增進病人安全並降低醫院醫療成本；目的：非計劃性中心靜脈導管滑脫率降低至0.18%以下；解決方案：運用團隊資源管理之概念，擬定改善方案：修訂護理標準、更新中心靜脈導管監測項目－井字固定管路並預留空間、製定審核指引及監測、安排在職教育課程、加強醫護溝通、提供衛教資訊及躁動病人加強保護性約束；結果：中心靜脈導管每月平均滑脫率由0.21%降為0.10%；結論：護理人員正確評估管路狀況及正確執行管路照護標準之策略，加上團隊合作以提供整合性照護，可增加病人管路安全及護理品質。

關鍵字

中心靜脈導管 ； 滑脫 ； 團隊資源管理

並列摘要

Background: The unplanned removal of central venous catheter (CVC) may cause instability of vital signs in patients, unnecessary re-insertion of catheter, increasing length of stay and health care expenses, or even mortality in severe cases. Therefore, if nursing staff could assess the tubing condition correctly and implementing standard tubing care, which may reduce the rate of unplanned removal of CVC, hospital expenses and improve the patient safety. Purpose: The rate of unplanned removal of CVC was below 0.18% Resolution: Implementation of team resource management (TRM) concept applied to establish the improvement scheme: Revised the nursing standards; updated CVC monitoring project-Tic-Tac Toe fixed method and reserved space; audited guidelines and monitoring its regularly; arrange education courses; promote the doctors and nurses communication; supplied health information; and judicious use of physical restraint in agitated cases. Results: The rate unplanned removal of CVC reduced from 0.21% to 0.10%. Conclusion: The nurses correctly assess tubing condition, implement of standard tubing care and combine TRM concept to provide integrated care by nursing staff, which can improve patient safety and quality of care.

並列關鍵字

central venous catheter ； unplanned removal ； team resource management

參考文獻

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