胸腔引流瓶更換作業之改善方案

A Project of the Improvement of Changing Chest Bottles

黃巧文(C. W. Huang) ； 林碧珠(B. J. Lin) ； 張瑛(Y. Chang) ； 黃秀梨(S. L. Hwang) ； 黃嗣棻(S. F. Hwang)

《護理雜誌》 46卷2期 (1999/04) Pp. 55-66

https://doi.org/10.6224/JN.46.2.55

摘要

本專案旨在簡化胸腔引流瓶（以下簡稱胸瓶）更換之作業，期能在簡化作業的同時，不會造成胸管留置病人的感染率和住院日之增加及降低引流效果等負面影響，而達到減少工作人員在更換胸瓶作業的時數，並降低成本。本專案以改變過程理論及品管QUACERS模式（The Quality Assurance Cost Efficiency Risk Staff Model）做爲改善方法之指引，採凖實驗法，以舊方案（每天更換玻璃瓶）做對照組，新方案（每三天更換玻璃胸瓶）當實驗組，比較兩組在感染率、引流效果和住院日之差異，對照與實驗兩組以隨機輪派收案，共收得35名開胸手術後胸管放置病人，實施結果發現，新方案較舊方案在估算更換胸瓶作業上，可節省39,757元／月的人力與物料成本、65小時／月的護理時數及22小時／月的工友清洗時數。結果顯示，兩組胸管留置病人在感染率、住院日及肺擴張不全方面並無顯著差異。故本專案在改善更換胸瓶作業上，能達到減少工作人員更換胸瓶作業的時數，降低成本，同時不會造成胸管留置病人的感染和住院日之增加及降低引流效果等負面影響。

關鍵字

更換胸腔引流瓶 ； 成本 ； 品管

並列摘要

This project was designed to improve the procedure of changing chest bottles in order to decrease labor expenditure and cost. The schedule of replacing chest bottles was changed from once per day to once every three days with quality control of infection rate. Change theory and quality control of QUACERS (The Quality Assurance Cost Efficiency Risk Staff Model) were used to guide the implementation of the project.
A quasi-experimental design was used to test the effectiveness of the project. Thirty-five post-thoracotomy patients with chest tubes were selected from the thoracic surgical unit of a medical center. The patients were assigned to the control and experimental groups based on the sequence of their transfer from SICU. The results showed that the project saved up to NT $39,757 per month in labor and material cost. Nursing hours decreased 65 hours per month. Time for cleaning the chest bottle also decreased 22 hours per month. There was no significant difference in the infection rate, length of stay, or atelectasis rate between the two groups. In conclusion, this project was effective in simplifying the procedure of changing chest bottles, and decreased cost and nursing hours without causing adverse complications.

並列關鍵字

changing chest bottles ； cost ； quality assurance