提升導尿管相關泌尿道感染組合式照護完整率

A Project for Improving the Completion Rate of Bundle Care on Catheter-Associated Urinary Tract Infection

陳姍婷(Shan-Ting Chen) ； 程瓊嬅(Chiung-Hua Cheng) ； 范麗桂(Li-Kuei Fan)

《臺大護理雜誌》 15卷1期 (2019/01) Pp. 218-232

https://doi.org/10.6740/NTUHJN.201901_15(1).0019

摘要

背景：本單位以急性腦中風病人居多，加上需留置導尿管密切監測輸出入量，使感染機會更為增加。2015年單位導尿管使用率（79.0%）及感染率（千分之3.8），均高於同年臺灣醫學中心內科加護病房（71.9%；千分之3.7）；完整的組合式照護已被證實為預防導尿管相關泌尿道感染的有效方法，2016年1至3月透過實際觀察照護情形發現組合式照護完整率為0%；認知正確率為74.4%；再經查檢與訪談結果得知組合式照護流程之18個步驟平均完成率為79.7%，由此得知護理師對其認知有待加強，照護上亦未全面落實。目的：提升「導尿管相關泌尿道感染組合式照護」完整率100%及「導尿管相關泌尿道感染組合式照護」認知正確率＞90%。解決方案：推展對應之改善措施，包含教育訓練、技術評核、內部競賽、影片宣導及團隊溝通等。結果：經改善後組合式照護完整率有效提升至100%，認知正確率提升至91.4%。結論：針對發生頻率及嚴重度高程序項目進行品質改善，確實能有效降低危害步驟出現之頻率，進而提升臨床照護品質。

關鍵字

腦中風 ； 導尿管相關泌尿道感染 ； 組合式照護

並列摘要

In stroke intensive care unit (ICU), most of the patients diagnosed with acute stroke are provided with a urinary catheter in order to closely monitor the amount of input and output, which increases the risk of catheter-associated urinary tract infection (CAUTI). In 2015, the urinary catheter utility rate (79.0%) and CAUTI rate (3.8 per mille) of our intensive care unit were higher than those in other internal medical ICUs from medical centers in Taiwan (71.9% and 3.7 per mille, respectively). The use of bundle care to prevent CAUTIs has been proven to be efficient. From January to March 2016, the completion rate was only 79.7% through actual observation and care. The approaches to improve the bundle care on CAUTI integrity include: education and training, technical evaluation, internal competition, video advocacy and team communication. Improvement in the rate of bundle care on CAUTI integrity was effectively increased to 100% and the knowledge accuracy raised to 91.4%. This project was aimed at improving the quality of the program with high frequency and severity. It can effectively reduce the frequency of the hazard steps and improve the quality of clinical care.

並列關鍵字

stroke ； catheter-associated urinary tract infection ； bundle care