提昇中心靜脈導管照護品質

本專案目的為提昇心臟加護單位中心靜脈導管照護品質，以降低血流感染率。本單位約半數病人有中心靜脈導管，現況分析發現其照護正確率僅有47.8%。探討原因包括設備：缺乏便利性之換藥設備；政策：單位無中心靜脈導管照護流程指引及定期監測機制。專案對策包括：（一）設備面：設計導管專屬換藥車；（二）政策面：包括1.創造支持性環境一為方便人員依流程圖示進行照護，制定中心靜脈導管照護步驟流程圖及圖片供人員參照；2.爲減少不必要的導管留置，制定中心靜脈導管必要性評估單，與醫師取得共識；3.制定單位評核政策與持續品質改善機制，含人員教育訓練及每月定期技術評核。經對策實施後照護正確率由3.8%提升至72%，2007至2008正確率為96.9%及98.3%，2006至2008中心導管血流感染率由1.84‰降為0.88‰及0.88‰，2006-2007血流感染率由2.18‰降為1.65‰，顯示評值成效佳，另外，製訂之中心靜脈導管照護流程可作為臨床護理人員參考的指引。

關鍵字

中心靜脈導管；照護品質；血流感染

並列摘要

The incidence of nosocomial infection in intensive care unit is the highest in hospital. Purpose of this project was to enhance central venous catheter (CVC) care quality to reduce bloodstream infection. About half of the patients in cardiac intensive care unit indwell CVC. In Jan. 2006, we survey 26 nurses and found the accuracy rate of CVC care was 47.8%. The reasons identified for this low accuracy rate included: lack of convenient equipment support and no policy to support the care, i.e. lack of catheter care procedure flow chart. We organized a task force and took actions to solve problems. To deal with equipment support, we designed a unit car to support the supply of equipments. To deal with the policy, we took three actions. 1. Diagram catheter care flow chart to help nurse's visual the procedures. 2. Develop an assessment sheet to communicate between medical and nursing professions to prevent prolong indwell the CVC. 3. Develop an audit policy to continue improves the CVC care. The results showed that 1. CVC care accuracy rate increased from 3.8% to 72%. In 2007 and 2008, the accuracy rate was 96.9% and 98.3%. 2. In 2006 to 2008, the incidence of bloodstream infection was decreased, from 1.84‰ to 0.88‰. The CVC infection rate also decreased from 2.18‰ to 1.65‰. We concluded that the clinical nursing staffs can apply the CVC guideline for best patient care.

並列關鍵字

central venous catheter ； care quality ； bloodstream infection

國際替代計量

提昇中心靜脈導管照護品質

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