题名

降低新生兒加護病房非計畫性氣管內管滑脫率

并列篇名

Reducing the Unplanned Removal Rate of Endotracheal Tubes in the Neonatal Intensive Care Unit

DOI

10.29494/LN.202103_22(1).0010

作者

黃麗卿(Li-Chin Huang)；林侑慧(Yu-Hui Lin)；李秉儀(Ping-I Lee)

关键词

新生兒加護病房 ； 非計畫性氣管內管滑脫 ； neonatal intensive care unit ； unplanned extubation

期刊名称

領導護理

卷期/出版年月

22卷1期（2021 / 03 / 01）

页次

131 - 146

内容语文

繁體中文
中文摘要

氣管內管對病人氣道的維護是很重要的，且非計劃性氣管內管滑脫率是醫療品質重要指標，一旦發生非計畫性滑脫，不僅對醫院成本造成耗費，也會危害病人安全。單位為新生兒加護病房，2016年氣管內管滑脫率高達1.15％，分析原因為無合宜之約束輔具、固定膠布滲濕未及時更換及未落實氣管內管照護安全。於2017年4月至2018年2月使用新生兒保護性約束輔具、改變氣管內管固定方式、訂定氣管內管照護評核表、製作教學影片及舉辦教育訓練等方案實施，非計畫性氣管內管滑脫率降至0％，達目標值。且護理人員於氣管內管照護安全執行率由46.4％提升至87.8％，有效提升了新生兒加護病房氣管內管照護品質，達年度病人安全工作目標。
英文摘要

The endotracheal tube is very important to the maintenance of the patient's airways, and the unplanned extubation (UE) rate is an important indicator to the medical quality. Once the unplanned removal occurs, apart from financial costing to the hospital, it will also endanger patient's safety. In 2016, the rate of UE in our neonatal intensive care unit was as high as 1.15%. After assessing the issue, we concluded problems include lack of suitable restraint aids, fixed adhesive tapes were not replaced in a timely manner, and lack of endotracheal tube care in-service education and securing techniques. After establish the methods aiming to reduce the risk of UE rate, those include apply the neonatal protective restraint aids, changes in the endotracheal tube adhesive tape fixation, design a protocol and checklist for securing endotracheal tubes care, produce teaching videos, organize educational training and so on. After implementing those measures, the rate of unplanned removal drop dramatically from 1.15% to 0%. In addition, the safety execution rate of nursing staff in endotracheal tube care increased from 46.4% to 87.8%. Our strategy has effectively improved the quality of endotracheal care in the neonatal intensive care unit, reduced the rate of UE, and reached the annual safety working goal for patients.
主题分类 醫藥衛生 > 預防保健與衛生學
醫藥衛生 > 社會醫學
参考文献
  1. 梁牡丹,范圭玲(2015)。降低兒科加護病房非計畫性氣管內管滑脫率之改善專案。護理雜誌，62(3 附冊)，39-48。
    連結：
  2. 鄭秋鳳,許雅雲,蘇綉雅,陳麗琴,林淑雯(2015)。降低新生兒加護病房非計劃性氣管內管拔除率。長庚護理，26(2)，167-178。
    連結：
  3. Bhandari, V.,呂學修（譯）(2013).新生兒學手冊：常見疾病診療及常用處置藥物寶典.合記.
  4. Dunn, J., & Baker, M. W. (2011, March 11). Daily sedation breaks and breathing trials help wean patients from ventilators safely. https://www.myamericannurse.com/daily-sedation-breaks-and-breathing-trials-help-wean-patients-from-ventilators-safely/
  5. Grant, M. J.,Balas, M. C.,Curley, M. A.,RESTORE Investigative Team(2013).Defining sedation related adverse events in the pediatric intensive care unit.Heart & Lung: The Journal of Critical Care,42(3),171-176.
  6. Hu, X.,Zhang, Y.,Cao, Y.,Huang, G.,Hu, Y.,McArthur, A.(2017).Prevention of neonatal unplanned extubations in the neonatal intensive care unit: A best practice implementation project.JBI Database of Systematic Reviews and Implementation Reports,15(11),2789-2798.
  7. Kangasniemi, M.,Papinaho, O.,Korhonen, A.(2014).Nurse’s perceptions of the use of restraint in pediatric somatic care.Nursing Echics,21(5),608-620.
  8. Kirwan, L.,Coyne, I.(2017).Use of restraint with hospitalized children: A survey of nurse’s perceptions of practices.Journal of Child Health Care,21(1),46-54.
  9. Lach, H. W.,Leach, K. M.,Butcher, H. K.(2016).Evidence-based practice guideline: Changing the practice of physical restraint use in acute care.Journal of Gerontological Nursing,42(2),17-26.
  10. Langley, G.,Schmollgruber, S.,Egan, A.(2011).Restraints in intensive care units--a mixed method study.Intensive & Critical Care Nursing,27(2),67-75.
  11. Longo, M. A.,Miller-Hoover, S.(2016).Clinical practice department: Effective decision making in the use of pediatric restraints.Journal of Pediatric Nursing,31(2),217-221.
  12. Nair, V.,Smith, H.(2020).Phased quality improvement interventions in reducing unplanned extubation in the neonatal ICU.Respiratory Care,65(10),1511-1518.
  13. Silva, P. S.,Reis, M. E.,Aguiar, V. E.,Fonseca, M. C.(2013).Unplanned extubation in the neonatal ICU: A systematic review, critical appraisal, and evidence-based recommendations.Respiratory Care,58(7),1237-1245.
  14. 王桂芸（校閱）(2014).基本護理學.永大.
  15. 許重梅,張炎德,魏美觀,李寶琳,林英芬,林惠釧(2013)。計劃性拔管與非計劃性拔管病人之預後。呼吸治療，12(2)，17-17。
  16. 溫淑如,范圭玲,吳美華,陳玉蓮,錢佳慧(2018)。降低兒童醫院加護病房非計劃性氣管內管滑脫率。台灣醫學，22(3)，297-310。
  17. 衛生福利部台灣病人安全資訊網（2020，2月20日）．醫院病安目標 109 年 -110 年 ．https://www.patientsafety.mohw.gov.tw/Content/zMessagess/contents.aspx?&SiteID=1&MmmID=621273300317401756&MSID=1071036444522033374
print cancel