提升兒科加護病房病童手圈佩戴正確率之改善

2013年兒料加護病房病童手圈佩戴，稽核發現病童手圈佩戴正確率為63.3%。故希望籍由探討護理師執行困難的原因，找出可行的解決辦法，以提升手圈佩戴正確率。經專案成員收集分析相關資料，歸納出手圈佩戴正確率低之原因，主要原因包括：1嬰幼兒皮膚薄且脆弱，手圈置於胸前衣物、2手圈條碼易髒污或刮損，條碼掃描裝置辨識度差、3放置動靜脈導管時將手圈移除，結束後未補上、○4未設立單位手圈佩戴標準作業規範內容，手圈佩戴步驟未標準化、5未定期作手圈佩戴正確評核、6單位未定期舉辦在職教育。目的期能達成護理師執行病童手圈佩戴正確率由63.3%，提升至95.0%。改善策略包含：1改良傳統手圈，採用親水性敷料保護嬰幼兒皮膚、2擬訂每班手圈核對及記錄、3設計創意手圈，採用人工薄膜加強手圈條碼辨識，製作電腦圖檔示範條碼辨識流程、4應用創意手圈於臨床、5修訂本院病人辨識過程完成率評核表，訂定標準程序執行流程、6舉辦病童手圈佩戴正確標準流程教育訓練、7建立病童手圈佩戴過程標準化步驟持續監控辦法，提升正確佩戴手圈的一致性。經計畫至執行後，評值改善策略之成效，發現改善後病童手圈佩戴正確率由63.3%，提升至98.6%，改善成效顯著。專案建立病童手圈佩戴標準程序，不但提升了病童手圈佩戴正確率，也擴展至兒科其他單位，有助於提升護理師執行手圈佩戴之正確性及病童安全。

關鍵字

兒料加護病房；創意手圈；佩戴正確率

並列摘要

Due to the low accuracy (63% as found in 2013) of pediatric ICU children's handring wearing, we wanted to find out the reasons and disclose some feasible and creative solutions. Major reasons for the low accuracy included: (1)For fear of hurting infants' soft skin, handrings were attached to their clothes in front of the chest; (2)Scan readability was low because the material was easily stained or scratched; (3)Handrings were not put back after arterial or venous catheters were placed; (4)The operation of handring-wearing was not standardized; (5)There was no regular evaluation of the accuracy of handring-wearing; and (6) No on-the-job training about the standards of operation on handring-wearing was given in the unit. We expected to raise the accuracy of handring-wearing from 63.3% to 95%. Methods: (1)Using hydrocolloid material to protect infants' skin; (2) Standardizing the process of handring wearing check and record-keeping; (3) Designing creative handrings and using artificial membrane to improve the readability; (4)Using the newly designed handrings clinically; (5)Amending the evaluation form of patient-identification process; (6)Offering training courses on correct handring-wearing process; and (7)Developing a monitoring system to enforce the process. Accuracy has significantly from 63.3% risen up to 98.6%. We suggested this project could be put into daily practice not only in the ICU unit but also in other pediatric units.

並列關鍵字

pediatric intensive care unit ； creative handrings ； the accuracy of handring wearing

參考文獻

黃璉華、黃嗣棻：病人安全是醫療照護之首要。護理雜誌2013;60:13-8。[Huang LH, Huang SF: Patient Safety as the First Priority in Healthcare. The Journal of Nursing 2013;60: 13-8.]"

陳綺芬、林雅真、江素真等：提升住院病人辨識率。北市醫學雜誌2008;5:163-171。[Chen CF, Lin YC, Chiang SC, et al: Improving the Inpatient Identification Rate. Taipei City Medical Journal 2008;5:163-171.]"

陳惠君、黃小芬、劉曾珊等：條碼科技於改善護理檢體採集標示錯誤之成效。澄清醫護管理雜誌2012;8:56-64。[Chen HC, Huang SF, Liu TS, et al: Implementation of Bar Code Technology to Minimize Labeling Errors of Specimens Collected by Nurses. Cheng Ching Medical Journal 2012;8:56-64.]"

吳金玲、林怡秀、黃小萍：兒科加護病房病人放置葉克膜護理流程完整性之改善方案。護理雜誌2012;59:65-72。[Wu CL, Lin IH, Huang HP: Nursing Approaches to Improve Extracorporeal Membrane Oxygenation(ECMO) Care in a Pediatric Intensive Care Unit. The Journal of Nursing 2012;59:65-72.]

Catalano K, Fickenscher K: Complying with the 2008 national patient safety goals. AORN J 2008;87:547-56."

國際替代計量

提升兒科加護病房病童手圈佩戴正確率之改善

全文下載

主題瀏覽