提升內科加護病房護理人員執行持續性靜脈血液濾過術正確性之成效

Project to Improve the Accuracy of Continuous Veno-Venous Hemofiltration in Medical Intensive Care Unit

10.29415/JMKN.201307_7(2).0005

陳美偵(Mei-Chen Chen)；陳淑卿(Shu-Ching Chen)；蔡佳憓(Chia-Hui Tsai)；黃佩珍(Pei-Chen Huang)

持續性靜脈－靜脈血液濾過術 ； 認知 ； 技術 ； Continuous veno-venous hemofiltration ； knowledge ； skill

馬偕護理雜誌

7卷2期（2013 / 07 / 01）

48 - 59

繁體中文

持續性靜脈－靜脈血液濾過術是藉由擴散或對流原理移除水分及代謝廢物的連續性腎臟替代療法。本專案目的為提升護理人員執行持續性靜脈－靜脈血液濾過正確性。現況中發現護理人員對持續性靜脈－靜脈血液濾過術認知僅37.5%，護理人員備物平均約15.7分，從持續性靜脈－靜脈血液濾過術預充（priming）到儀器接置病人身上平均約花費2.45小時，排除警訊平均時間為5－10分鐘，護理人員執行持續性靜脈－靜脈血液濾過術正確性僅達21.4%，顯示護理人員對於持續性靜脈－靜脈血液濾過術的認知與技術仍有待提升。因此，綜合以上結果，進行本專案之改善方案：（1）安排護理人員持續性靜脈－靜脈血液濾過術訓練，（2）製作持續性靜脈－靜脈血液濾過術多媒體教學光碟，（3）舉辦持續性靜脈－靜脈血液濾過術儀器操作模組練習，（4）製作持續性靜脈－靜脈血液濾過術中文版操作手冊，（5）制定持續性靜脈－靜脈血液濾過術備物一覽表，及（6）制訂持續性靜脈－靜脈血液濾過術品質監測。經過本專案改善後護理人員對持續性靜脈－靜脈血液濾過術認知由37.5%增加至93.2%，護理人員備物平均時間由原本的15.7分鐘縮減至3.75分鐘，持續性靜脈－靜脈血液濾過術過濾預充（priming）到儀器接置病人身上使用由原本的2.45小時減少至45－55分鐘，排除警訊及解決問題的時間也由原先的5－10分鐘下降至30秒－2分鐘，護理人員執行持續性靜脈－靜脈血液濾過術正確性由28.9%增加至92.2%，顯示此專案有良好的成效。

Continuous veno-venous hemofiltration is a replacement therapy which removing water and metabolizing waste by diffusion or convection. The purpose of the project was to improve the accuracy of continuous veno-venous hemofiltration for nurse staffs. Before this project, the accurate percentage of the nurses' knowledge on continuous veno-venous hemofiltration was 37.5%, the average time for preparing material was 15.7 minutes, the average time from priming to connecting to patients was 2.45 hours, the average time of relief alarm was 5-10 minutes, and the accurate percentage of the nurses' skill on performing continuous veno-venous hemofiltration was 21.4%. These data indicated that nurses' knowledge and skills of continuous veno-venous hemofiltration needed to be improved. After analyzing the current procedures, current project proposed improvements include: (1) arranging nurses to receive the continuous veno-venous hemofiltration training; (2) developing multimedia teaching CD; (3) planning continuous veno-venous hemofiltration clinical practice; (4) building Mandarin manual for continuous veno-venous hemofiltration; (5) making material list of preparation; and (6) constructing quality monitor for continuous veno-venous hemofiltration. Substantial improvements were observed afterward: (1) the accurate percentage of the nurses' knowledge on continuous veno-venous hemofiltration has increased to 93.2%; (2)the average time for preparing material has decreased to 3.75 minutes; (3) the average time from priming to connecting to patients has decreased to 45-55minutes; (4) the average time of relief alarm has decreased to 30 second to 2 minutes; (5) the accurate percentage of the nurses' skill on performing continuous veno-venous hemofiltration has increased to 92.2%. The project was effective.