降低心血管外科手術病人壓瘡發生率之專案

A Project for Lowering the Incidence of Pressure Ulcers in Cardiovascular Surgical Patients

10.6386/CGN.201909_30(3).0007

辜漢章(Han-Chang Ku)；吳昱蓁(Yu-Jhen Wu)；黃琬琴(Wan-Chin Huang)；蔡宜蓁(Yi-Tseng Tsai)；曾偲華(Szu-Hua Tseng)；張嘉蘋(Jia-Ping Chang)

心血管外科手術 ； 壓瘡預防 ； 發生率 ； cardiovascular surgery ； pressure ulcer prevention ； incidence rate

長庚護理

30卷3期（2019 / 09 / 01）

361 - 371

繁體中文

壓瘡是長時間手術之常見合併症，佔所有壓瘡發生率40%以上，也導致增加感染機率、延長住院天數及增加醫療成本。本院心血管外科手術壓瘡發生率為9%，病人因發生壓瘡導致住院天數倍增，護理時數與醫療成本也相對增加，引發本專案改善動機。分析主因為護理師缺乏壓瘡防護教育訓練、判別壓瘡標準不一、心血管外科手術時間過長、無菌布單過重及不熟悉心血管外科手術流程。故舉辦「壓瘡評估與照護」在職教育、培育護理師判別壓瘡能力、建立雙重核對機制、修改心血管外科皮膚防護操作流程、改變鋪單方式以防水布單取代布中單及以床邊教學模式建立心血管外科流動護理師操作流程。執行改善措施後壓瘡發生率由9%下降至5%，壓瘡認知得分由71.3%上升至98.8%，提升心血管外科手術團隊壓瘡預防之共識與手術全期照護品質。

Patients undergoing long operation procedure are at a greater risk of developing a pressure ulcer, accounting for 40% of the total cases. Pressure ulcer can increase the risk of infections, lengthen the length of stay, and increase the duration and costs of nursing care. We collected data on patients who underwent surgery between September and December in 2015 and found that the incidence of pressure ulcers in cerebrovascular surgical patients was 9%. This project was developed to solve the problem of pressure ulcers by setting up standard preventive procedures, creating continuing education courses and bed-side teaching, building the double check review system, and establishing cerebrovascular team resource management. The incidence of pressure ulcer in cerebrovascular surgical patients between June and September in 2016 reduced to 5% and nurses' understanding of preventive measures increased from 71.3% to 98.8% after the improvement project was carried out. This project improves the awareness of nurses and thus provides a better quality of operative nursing care and also strengthens the cerebrovascular team work.

1. 黃玉玲、林慧玲、王方、吳淑芳(2015)。預防手術後壓瘡照護流程之發展。護理雜誌，62(6)，98-104。
   連結：
2. Association of Operating Room Nurses. (2013). Recommended practices for positioning the patient in the perioperative practice setting. Retrieved from http://www.mediteksurgical.ca/wp-content/uploads/2013/02/AORNRecommended Practices for Positioning the Patient in the Perioperative Practice Setting.pdf
3. Beckett, A. E.(2010).Are we doing enough to prevent patient injury caused by positioning for surgery?.Journal of Preoperative Practice,20(1),26-29.
4. Engels, D.,Austin, M.,McNichol, L.,Fencl, J.,Gupta, S.,Kazi, H.(2016).Pressure ulcers: factors contributing to their development in the OR.AORN Journal,103(3),271-281.
5. Haesler, E.,National Pressure Ulcer Advisory Panel (U.S.),European Pressure Ulcer Advisory Panel,Pan Pacific Pressure Injury Alliance(2014).Prevention and treatment of pressure ulcers: clinical practice guideline.Osborne Park, Western Australia:Cambridge Media.
6. Kandilov, A. M.,Coomer, N. M.,Dalton, K.(2014).The impact of hospital-acquired conditions on medicare program payments.Medicare Medicaid Research Review,4(4),E1-E23.
7. Low, L. L.,Vasanwala, F. F.,Tay, A. C.(2014).Pressure ulcer risk assessment and prevention for the family physician.Proceeding of Singapore Healthcare,23(2),142-148.
8. National Pressure Ulcer Advisory Panel. (2016). NPUAP pressure injury stages. Retrieved from http://www.npuap.org/resources/educational- and-clinical-resources/npuap-pressure-injurystages/
9. Rao, A. D.,Preston, A. M.,Strauss, R.,Stamm, R.,Zalman, D. C.(2016).Risk factors associated with pressure ulcer formation in critically ill cardiac surgery patients: a systematic review.Journal of Wound Ostomy Continence Nursing,43(3),242-247.
10. Shaw, L. F.,Chang, P. C.,Lee, J. F.,Kung, H. Y.,Tung, T. H.(2014).Incidence and predicted risk factors of pressure ulcers in surgical patients: experience at a medical center in Taipei, Taiwan.BioMed Research International,416896,1-9.
11. 財團法人醫院評鑑暨醫療品質促進會(2014)．台灣臨床成效指標．取自 http://tcpi.jct.org.tw/tcpi/ [Joint Commission of Taiwan, ROC. (2014). Taiwan clinical performance indicator. Retrieved from http://tcpi.jct.org.tw/tcpi/]
12. 陳妮婉、張彩秀、張素惠(2013)。護理人員壓瘡預防行為之系統性文獻查證。澄清醫護管理雜誌，9(2)，40-47。
13. 鄭孟昭、莊阿月(2011)．運用醫療團隊資源合作降低心臟手術病患壓瘡之成效．取自http://www.chimei.org.tw/main/cmh_department/53000/nurse_epaper/nurse10006/menu06_04.html。[Zheng, M. Z., & Chuang, A. Y. (2011). Using healthcare team resource management to reduce the pressure ulcer rates in cardiovascular surgical patients. Retrieved from http://www.chimei.org.tw/main/cmh_department/53000/nurse_epaper/nurse10006/menu06_04.html]

1. (2024)。一位食道切除個案再次重建之手術全期護理經驗。志為護理-慈濟護理雜誌，23(1)，128-138。