降低胃腸肝膽科病房病人新壓瘡發生率之專案

A Program to Reduced Newly Develop Pressure Injury for the Division of Gastroenterology and Hepatology Inpatients

10.29494/LN.201809_19(3).0008

溫明寰(Ming-Huan Wen)；連靜雯(Ching-Wen Lien)；塗勝翔(Sheng-Hsiang Tu)

壓瘡 ； 翻身 ； 護理創意 ； Pressure injury ； Reposition ； Nursing innovation

領導護理

19卷3期（2018 / 09 / 01）

96 - 110

繁體中文

壓瘡是臥床制動病人常見問題，也是臨床照護品質重要指標。專案病房2014~2015年新壓瘡發生率有逐漸增加趨勢，2015年1-11月共52件通報新增壓瘡，發生率為0.394%，遠高於閾值。經現況分析發現病人壓瘡高危險群比例高、護理師預防壓瘡及鑑別認知不足、無翻身紀錄或標示、照顧者未確實至少2小時翻身且無查核機制、醫療設備局部壓迫、其他非照護因素如將失禁性皮膚炎誤判為壓瘡以及登錄錯誤等。擬定下列措施進行改善：萬用翻身時間板設計製作、建立減壓設備使用標準、進行宣導教育訓練、稽核監測、建立專科管路照護及減壓設備使用常規，壓瘡發生率由0.394%下降至0.099%，藉專案進行有效降低壓瘡發生率，提升照護品質。

The pressure injury is a common issue in bedridden patients and also an important indicator in clinical care. The incidence of pressure injuries increased gradually in the division of specific ward since 2014 to 2015. There are total of 52 new pressure injuries reported during January to November 2015 with the incidence of 0.394%, which was above the average rate. Analysis discovered that there are several risk factors for those cases. They are firstly the high risk population and poor prevention for pressure injury, lack of reposition record, the poor performance of health giver who neglect repositioning every 2 hours, medical device compression and finally other factors discovered including mistaking the incontinence associated dermatitis as pressure injury and medical record error. We developed the following strategies to prevent the issues, including the repositioning time reminder, standardizing the use of the support surface, staff training program, internal auditing and monitoring system and hence reinforcement of medical device care. The incidence was reduced from 0.394% to 0.099% as data recorded. These strategies worked effectively in preventing the pressure injuries and lead to a better patient care quality.

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