降低頭頸癌顯微皮瓣重建術後壓瘡改善方案

Improvement Plan to Reduce Pressure Ulcer After Microvascular Free Flap Reconstruction for Head and Neck Cancer

10.6320/FJM.202007_24(4).0011

何宜軒(Yi-Hsuan He)；詹靜媛(Jing-Yuan Zhan)

頭頸癌 ； 顯微皮瓣重建手術 ； 壓瘡 ； 完全臥床 ； head and neck cancer ； microvascular free flap reconstruction ； pressure ulcer ； complete bed

台灣醫學

24卷4期（2020 / 07 / 25）

434 - 444

繁體中文

壓瘡是常見的照護問題，本單位於2015年壓瘡盛行率為2.69％，高於醫學中心平均值0.50％。其中頭頸癌顯微皮瓣重建術後壓瘡盛行率高達19.8％。主要原因有：未積極參與教育訓練、未執行皮膚完整性檢查、未保持病人身體清潔及乾燥、頭部置中完全臥床、未使用支撐物／壓瘡輔具且未添購預防性敷料、病人未保持其移動。本專案藉由制定多項準則：擬定每年每位在職壓瘡課程時數、制定術後皮膚檢查流程、修訂術後照護事項：圓滾木翻身準則、更換頸下看護墊準則、使用壓瘡輔具。降低頭頸癌顯微皮瓣重建術後壓瘡至8.99％。護理照護完整率由70％提升至96.1％。希望藉由此專案分享至相關單位，提升護理照護品質。

Pressure ulcer is a common problem for nursing care. In 2015, the prevalence of pressure ulcer was 2.69% in this department, higher than an average of 0.50% for a medical center. In addition, the prevalence of pressure ulcer after microvascular free flap reconstruction for head and neck cancer was 19.8%. The main reasons for the high prevalence included nurses' passive participation in education and training, failure to check skin integrity, failure to maintain patient body cleanness and dryness, patients' complete bedridden status with the head as a center, nonuse of braces or pressure-relief assistive devices, lack of preventive dressing, and failure to help patient position their body. This study established multiple criteria such as stipulation of each individual's in-service training hours related to pressure ulcer per year, processes of postoperative skin examination, amended postoperative caregiving requirements, logrolling principles, principles of replacing care pads under the neck, and use of assistive devices for alleviating pressure ulcer. By implementing these criteria, the prevalence of pressure ulcer after microvascular free flap reconstruction for head and neck cancer was reduced to 8.99%, and the care completion rate was increased from 70% to 96.1%. The results of this study can serve as a reference for relevant units to increase quality of nursing care.