運用跨領域團隊模式降低神經外科病房泌尿道感染率

「泌尿道感染」造成病人傷害增加醫療支出是可預期的，本院神經外科病房尿道感染率居全院之冠，院方建議神經外科照護團隊以「團隊資源管理」手法進行預防泌尿道感染專案改善，經現況分析確認原因：(1)未依標準步驟執行導尿管置入與照護、(2)缺乏教育訓練、(3)未參與尿管組合式照護、(4)無提示尿管移除規範、(5)照護衛教指導不確實、(6)病床太低導尿管落地。為達專案目的經實施對策：(1)修訂拍攝導尿管置入教學影帶。(2)舉辦在職教育訓練。(3)參與導尿管組合式照護規範。(4)電腦系統增設導尿管留置提醒視窗。(5)製作並推行導尿管留置注意事項衛教單張，懸掛於床尾。(6)增設改善尿袋不落地設備後。泌尿道感染率由平均千分之2.6下降至千分之1.21，達到專案目的，並提升管路照護品質的完整性。

關鍵字

泌尿道感染；團隊資源管理

並列摘要

IUrinary tract infection (UTI) may cause additional patient injuries and leads to increased medical expenditures. In our hospital, the UTI incidence rate in Neurosurgery ward was the highest among all wards, with the injuries caused by Urinary tract infection becoming increasingly severe. The hospital suggested that the Neurosurgery team to develop a project aiming at preventing UTI by using ＂Team Resource Management＂. After analyzing the Neurosurgery ward current situation, the causes of UTI were confirmed: (1) foley catheterization and care did not follow standard operating procedures, (2) lack of continuous education and training, (3) not attached with foley bundle care, (4) lack of catheter removal, (5) care education is inaccurate, (6) The bed is too low so that catheters touched the ground. To achieve this improving project goal, strategies developed for preventing the incidences of UTI are listed as followed: (1) to revised and film the catheterization process into education video, (2) to hold continuous education program, (3) to apply foley bundle care,(4) to add foley catheterization reminder window in computer system, (5) to develop foley catheter caring notifications and education leaflets which could be hanging on the end of beds, (6) to add equipment to avoid urine bag from approaching the ground. After applying this improving project, UTI incidences decreased from 2.6 per mille to 1.21 per mille; this result indicates that not only the goal of reducing UTI incidences was achieved, but also the complete rates and quality of catheter care were promoted.

並列關鍵字

Urinary tract infection ； team resource management

參考文獻

林佳慧、陳玉如、蔣立琦(2013)‧應用跨專業領域團隊之實證醫療促進臨床病人安全及照護品質‧榮總護理，30(2)，121-129。

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。

黃萬翠、王復德、陳瑛瑛、孫淑美(2014)‧應用電腦提醒拔除導尿管機制對導尿管使用及尿路感染之影響‧護理暨健康照護研究，10(1)，70-77。

Hooton, T. M., Bradley, S. F., Cardenas, D. D., Colgan, R., Geerlings, S.E., & Rice, J.C. (2010). Diagnosis, prevention, and treatment of catheter associated urinary tract infection in adult: 2009 international clinical practice guidelines from the infectious diseases society of America. Clinical Infectious Diseases, 50(5), 625-663.

Shea-Lewis, Anne. (2009). Teamwork: crew resource management in a community hospital. Journal for Healthcare Quality, 31(5), 14-18.

國際替代計量

運用跨領域團隊模式降低神經外科病房泌尿道感染率

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