降低門診化學治療室化學治療藥物外滲之改善專案

A Project to Reduce the Risk of Extravasation at an Outpatient Chemotherapy Unit

林錦雪(Chin-Hsueh Lin) ； 劉志俐(Chin-Li Liu) ； 洪敏瑛(Ming-Ying Hong)

《腫瘤護理雜誌》 13卷1期 (2013/06) Pp. 27-39

https://doi.org/10.6880/TJON.201306_13(1).04

摘要

化學治療藥物外滲會對病人造成身心傷害，故如何預防是重要環節。本專案旨在降低門診化學治療室化學治療藥物外滲問題，因2010年1月至6月外滲率高出目標值，分析原因，發現病人對化學治療管路安全維護認知僅87.5%，確認問題為：病人對指導內容不清楚、缺乏完善指導工具、靜脈留置針固定不良、廁所設施問題、人員未確實指導、注射部位選擇不當；經改善指導工具與方式、規範留置針固定方式、加強廁所環境安全、增設稽核制度及制訂禁忌注射部位及管路觀察次數等方案後，化學治療藥物外滲率由0.023%降至0.007%，病人對化學治療管路安全維護認知正確率達100%。本專案不僅以多元化護理指導提升病人及家屬認知和遵從性，也因落實病人就醫環境安全設施之維護，有效預防化學治療外滲事件，得以確保門診治療之照護品質。

關鍵字

化學治療室 ； 化學治療藥物 ； 外滲

並列摘要

Extravasation of chemotherapeutic agents may cause severe physical and mental injuries to patients; therefore, prevention of extravasation is a crucial issue. The extravasation rate from January to June in 2010 at our outpatient chemotherapy unit was higher than that we had expected. Hence we developed a project to reduce the extravasation rate. After analyzing the problems, we found that only 87.5% of patients acknowledged the safety issues regarding chemotherapy administration with further analysis, In addition, we also identified several other problems including poor understanding of instructions by patients, the lack of a good instruction tool, poor fixation of catheters, the inadequacy of facilities in the restroom, the patient's lack of knowledge on operating he faculty, and the improper site of catheter indwelling. After improving the tools and manuals of the safety instruction, making a general rule about catheter fixations, improving the environmental safety and equipments, implementing an auditing system, specifying the contraindicated injection site and frequency of tubing observations, the extravasation rate reduced from 0.023% to 0.007%. Furthermore, the rate of patients’ cognition of the safety on chemotherapy and compliance reached 100%. In conclusion, this project disclosed the importance of multiple diversified nursing care to improve the patient safety and the insights of the families, and it was very helpful to prevent extravasation of the intravenous injection drugs and to improve the quality of outpatient chemotherapy.

並列關鍵字

outpatient chemotherapyunit ； chemotherapy ； extravasation