降低老年人直腸超音波與尿流速重複檢查發生率之護理專案

攝護腺肥大是男性老年人常見疾病之一，臨床上須倚賴「直腸超音波與尿流速檢查」來診斷，而該檢查在本院佔泌尿科所有檢查中排行榜第一位，分析2018年1月至4月因老年病人不耐等待導致抱怨頻傳，發現該檢查項目老年長者的重複檢查發生率高達75%，不僅造成醫療資源浪費，更衍生病人抱怨、降低醫療照護品質，故引發專案小組改善老年人直腸超音波與尿流速檢查之作業流程。根據現況分析主要問題：1.護理師欠缺對老年人集尿相關專業知識；2.護理師未正確執行老年人直腸超音波與尿流速檢查照護；3.缺乏查核表；4.缺乏適合老年人檢查之集尿和擺位輔助設備；5.缺乏安全照護標準作業流程。經文獻查證與團隊腦力激盪，擬定解決對策：研發檢查擺位和集尿輔具、設計視覺圖示記憶與簡易口訣、製作簡易海報和手機智慧應用程式APP、辦理教育訓練及建立標準作業規範。專案實施結果發現重複檢查發生率由75%降低至0%；護理師對老年長者直腸超音波與尿流速認知正確率由56%提升至100%；護理師的直腸超音波與尿流速檢查執行正確率由50%提升至97%。顯示本專案能強化護理師對老年長者直腸超音波與尿流速檢查執行之正確率，有效降低重複檢查發生率，也讓病人、家屬透過醫病決策共享的方式，提升病人滿意度及醫療照護品質。

關鍵字

老年人；攝護腺肥大；護理；直腸超音波檢查；尿流速檢查

並列摘要

Prostate hypertrophy has become one of the most common diseases in elderly men. It is necessary to rely on the test of ＂transrectal ultrasound and urine flow rate＂ for diagnosis. In addition, the transrectal ultrasound and urine flow rate tests in our hospital rank first among all kinds of urology examinations. Frequent complaints due to the impatient waiting of elderly patients were found and the incidence of repeated transrectal ultrasound and urinary flow rate examinations based on analysis from January to April 2018 was as high as 75%. Inefficient procedures may not only waste medical resources, but also induce complaints from patients and decrease the quality of medical care. Therefore, the project team tried then to reduce the incidence of repeated examinations of rectal ultrasound and urine flow in the elderly. According to the current situation analysis, the major problems are: 1. Lack of professional knowledge related to urine collection for the elderly in nursing staff; 2. Failure to properly perform rectal ultrasound and urine flow tests and care for the elderly in nursing staff; 3. Lack of checklists; 4. Lack of urine collection and positioning aids suitable for elderly inspections; 5. Lack of standard operating procedures. After literature review and our team members' brainstorming, strategies were draft including: development of inspection positioning and urine collection aids, combination with visual icon memory and simple formulas, development of posters and mobile APP, establishing nursing standard operation procedure and designing education training. The effectiveness of this project showed the incidence of repeated inspections was reduced from 75% to 0%; the cognitive accuracy rate of nurse increased from 56% to 100%; the implementation accuracy rate increased from 50% to 97%. Furthermore, the family members of patients have the opportunity to share medical decisions and improve the quality of patient care.

並列關鍵字

elderly ； enlarged prostate ； nursing ； transrectal ultrasound ； urine flow rate

參考文獻

王本正、周信甫、張郁玫（2014）．銀髮族醫療照護機構之流程再造．福祉科技與服務管理學刊，2（2），129-140。https://doi.org/10.6283/JOCSG.2014.2.2.129

李鴻春、蔡芳文、林惠如、劉介宇、謝佳容（2018）．長期照護機構老人的身體平衡功能與跌倒發生的前瞻性研究．新臺北護理期刊，20（1），P11-25。https://doi.org/10.6540/NTJN.2018.1.002

汪秀玲、洪純隆、關皚麗（2011）．健康照護系統中潛在浪費的衡量與國際比較．台灣醫學15（3），233-243。https://doi.org/10.6320/FJM.2011.15(3).01

吳子翔、黃一勝（2017）．男性尿失禁的定義、診斷與治療．台灣醫學，21（5），475-480。https://doi.org/10.6320/FJM.2017.21(5).6

吳婷婷、呂宜臻、張磊（2017）．行動科技導入於護理教育之現況探討．護理雜誌，64（6），19-25。https://doi.org/10.6224/JN.000079

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