提升某區域教學醫院內科病房大腸鏡檢查腸道清潔度之改善專案

背景：腸道清潔不足可能導致病變未被發現、取消鏡檢、增加檢查時間及增加潛在併發症的風險。高品質的腸道準備是發現早期的結腸病變的基石。這個專案的目的為提高大腸鏡檢查前的腸道清潔度。起初，腸道準備只有39%的患者達到良好/優良的程度。另外，護理人員對大腸鏡檢之腸道清潔所需之飲食、藥物及護理指導的平均認知率僅有59.9%。目的：此專案的目的為提高大腸鏡檢查前的腸道清潔度。解決方案：我們制定大腸鏡檢查腸道清潔護理指導標準作業流程、大腸鏡檢稽查列表、製作大腸鏡檢護理指導手冊及舉辦相關在職教育，並將其成果運用於另外30位住院病人並評估成效。結果評值：經專案介入後，大腸鏡檢腸道清潔度達乾淨之程度提升至80%，不僅達專案之目的，其中護理指導的認知部份由原有50.3%提升至100%，且對大腸鏡檢查前飲食、藥物使用及護理指導之平均認知率由59.9%提升至94.1%。結論：經專案執行後腸道清潔改善成效良好，足以推廣至全院一般急性病房。

關鍵字

大腸鏡檢查；腸道清潔；護理指導

並列摘要

Background: Inadequate bowel preparation for colonoscopy may result in missing lesions, cancelling procedures, extending screening time and increasing risks of complications. High-quality bowel preparation before colonoscopy is essential for detecting early colon lesions. Before the project, only 39% of the bowel colonoscopy preparations reached the good/excellent levels. On top of that, the nurses only had 59.9% average recognition rate on proper bowel preparation, including diet modification, monitoring of intake and output, drugs for gut lavage, and time to stop anti-platelet or anti-coagulant drugs. Purpose: The purpose of the project is to improve the efficacy of bowel preparation for colonoscopy. Methods and Materials: The quality improvement project includes revising the standard operating procedure, developing a new checklist for colonoscopy preparation, and a handbook for bowel preparation instruction. All nurses in our ward received on-job trainings regarding the new protocol. The results of the quality improvement project were evaluated afterward on bowel preparation of 30 patients in our ward. Results and Discussion: After the quality improvement project, the percentage of good/excellent bowel preparation advanced to 80%. The nurses' recognition rate on nursing instruction increased from 50.3% to 100%. The overall average recognition rate of nurses for proper bowel preparation knowledge, including diet and medication and nursing instruction, improved from 59.9% to 94.1%. Conclusions: The project is effective for improving the bowel preparation before colonoscopy. It is worth to be applied to other wards of the hospital.