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看護師による安全な静脈注射実施に向けた北海道大学病院での取組み : 静脈注射エキスパートナース育成を中心とした教育体制の構築
岡田, きょう子;本間, 美恵;坂口, 登子;中西, 千代美;船木, 典子;良村, 貞子
Permalink : http://hdl.handle.net/2115/39066
JaLCDOI : 10.14943/38115
KEYWORDS : intravenous infusion;nurse;expert;safety;institutional approach;静脈注射;看護師;エキスパート;安全;組織的取組み
Abstract
平成14年9月，厚生労働省は「看護師等による静脈注射は診療補助行為の範疇である」と法解釈を変更した。本院は特定機能病院として，高度先端医療を提供しているため，患者は道内の広域から紹介され，抗がん剤等の危険性が高い薬剤を使用する場合が多い。患者の安全を保障したうえでの看護師による静脈注射の実施は，経験年数が3年未満の看護師が約3割を占める中，いかに環境を整備し，静脈注射に係る高度な知識，技術の習得に向けた教育体制を構築するかが鍵であった。厚生労働省通知の医師等との“適切な業務分担”等を踏まえ，病院内に「静脈注射に関する検討委員会」を設置し，施設基準を作成し，看護部委員会で教育体制の構築を図り，平成20年5月から看護師による静脈注射の実施を開始した。本稿では「静脈注射に関する検討委員会」設置に至る組織化までの過程と，集合教育と部署内教育を組み合わせることを方針に，静脈注射エキスパートの育成を中心とした教育体制の構築の実際と今後の課題について述べる。
The Ministry of Health, Labour and Welfare in Japan adopted in 2002 a new legal interpretation that stated that nurses were able to practice intravenous infusions under physicians' orders. The Hokkaido University Hospital is an advanced treatment facility that employs state-of-the-art medical technology in its role as the healthcare hub in Hokkaido. There is a high likelihood that patients receiving cancer therapy at this hospital will require high-risk drugs administered by intravenous infusions. However, nurses' infusion safety practices were found to be less than optimal because approximately 30% of nurses had fewer than three years of experience. We therefore aimed to establish an educational system whereby nurses could acquire advanced knowledge and skills pertaining to safe intravenous infusions. Our hospital founded a special committee that reviewed infusions performed by nurses. The committee created facility-wide criteria that have promoted a concrete division of roles among health care professions. A session run by expert nurses resulted in the establishment of a unique system to educate nurses about intravenous infusions. All Nurses began performing the infusions in 2008. This study describes the process underlying the approach of the institution and the committee as well as the expert nurse session that combined special lectures, group work, and unit learning. We also describe possible limitations of the institutional approach and the educational system.
The Ministry of Health, Labour and Welfare in Japan adopted in 2002 a new legal interpretation that stated that nurses were able to practice intravenous infusions under physicians' orders. The Hokkaido University Hospital is an advanced treatment facility that employs state-of-the-art medical technology in its role as the healthcare hub in Hokkaido. There is a high likelihood that patients receiving cancer therapy at this hospital will require high-risk drugs administered by intravenous infusions. However, nurses' infusion safety practices were found to be less than optimal because approximately 30% of nurses had fewer than three years of experience. We therefore aimed to establish an educational system whereby nurses could acquire advanced knowledge and skills pertaining to safe intravenous infusions. Our hospital founded a special committee that reviewed infusions performed by nurses. The committee created facility-wide criteria that have promoted a concrete division of roles among health care professions. A session run by expert nurses resulted in the establishment of a unique system to educate nurses about intravenous infusions. All Nurses began performing the infusions in 2008. This study describes the process underlying the approach of the institution and the committee as well as the expert nurse session that combined special lectures, group work, and unit learning. We also describe possible limitations of the institutional approach and the educational system.
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