運用團隊資源管理降低呼吸器相關肺炎感染密度

Applying Team Resource Management to Reduce the Infection of Ventilator-Associated Pneumonia

林怡君(I-Chun Lin) ； 高錦慧(Ching-Hui Kao)

《源遠護理》 11卷2期 (2017/07) Pp. 41-50

https://doi.org/10.6530/YYN/2017.3.1

摘要

呼吸器相關肺炎是加護病房最常見的院內感染之一，本單位於2011年7月開始推行「呼吸器相關肺炎組合式照護（VAP Care Bundle）」，2013年第一季VAP感染密度攀升高達千分之5.11，且發生一例醫療糾紛打擊團隊士氣。專案小組調查確立問題為：團隊成員各做各的缺乏交集與共識、對VAP Care Bundle認知不足、缺乏VAP Care Bundle標準作業流程、電動床無高度顯示及缺乏殺菌成分漱口水等。運用團隊資源管理概念擬定解決策略，包含制定VAP Care Bundle標準作業流程、舉辦教育訓練、標示床頭搖高30度位置、醫囑開立含0.2% Chlorhexidine潄口水及每次聯合巡診討論VAP Care Bundle等措施後，VAP感染密度下降至千分之1.10、VAP Care Bundle認知正確率由73.4%提升達97.6%、VAP Care Bundle執行正確率由57.8%提升至96.4%。此專案不僅增進團隊成員間的有效合作，更提升醫療照護品質。

關鍵字

團隊資源管理 ； 呼吸器相關肺炎 ； 組合式照護

並列摘要

Ventilator-associated pneumonia (VAP) is a common nosocomial infection in intensive care units (ICUs). The VAP Care Bundle was implemented in our unit in July 2011. However, VAP infection rates remained high (5.11%) throughout the first quarter of 2013; a medical dispute incident also occurred during this same period. Based on the literature review and practical observations, the special team focused on correcting the following aspects: (1) lack of coordination between team members and their unfamiliarity with the VAP Bundle, (2) knowledge regarding the VAP Bundle was insufficient, (3) the lack of standard operating procedures for the VAP Bundle, (4) the absence of an altitude display monitor attached to the medical electric bed, and (5) a shortage of antibacterial mouthwash. The improvement measures implemented included team resource management (TRM) with the following aspects: (1) establishment of the VAP Bundle SOP, (2) conducting education and training programs about the VAP Bundle, (3) installation of a Mark 30° upper adjustable on the medical beds, (4) using 0.2% chlorhexidine mouthwash along with the doctor’s prescription, and (5) conducting routine meetings afterward patient consultation. VAP infection rates decreased to 1.10 per mille, and the VAP Bundle accuracy rate increased from 57.8% to 96.4%. The ICU team members' awareness of accuracy rates increased from 73.4% to 97.6%. The risk identification and associated TRM project improved teamwork and the quality of care in the ICU.

並列關鍵字

team resource management ； ventilator-associated pneumonia ； care bundle

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