| 题名 |
運用多元策略降低重症病人壓力性損傷發生率 |
| 并列篇名 |
Applying Multiple Methods to Reduce the Incidence of Pressure Injury in Critically Ill Patients |
| DOI |
10.6540/NTJN.202309_25(2).0006 |
| 作者 |
江明珍(Ming-Chen Chiang)；陳惠芳(Hui-Fang Chen)；朱育瑧(Yu-Jen Chu) |
| 关键词 |
壓力性損傷 ； 皮膚照護 ； 重症護理 ； 發生率 ； 減壓設備 ； comprehensive skin assessment checklist ； pressure injury ； critical care ； divergent thinking ； pressure-relief mattress |
| 期刊名称 |
新臺北護理期刊 |
| 卷期/出版年月 |
25卷2期（2023 / 09 / 01） |
| 页次 |
66 - 76 |
| 内容语文 |
繁體中文;英文 |
| 中文摘要 |
重症病人因疾病複雜、活動障礙、長期臥床及升壓劑使用造成知覺感受度下降，發生壓力性損傷機率偏高，壓力性損傷不僅會造成疼痛、增加感染率、延長住院天數、增加死亡率及醫療消費，影響甚鉅，因此預防壓力性損傷發生是重症護理照護之重要議題。本單位自2019年壓力性損傷發生率為0.81%，高於2018年0.78%，亦高於全院內科加護病房的平均值0.74%，故成立專案小組。現況分析發現護理師對預防壓力性損傷照護認知與照護行為不足，壓力性損傷照護達成率僅達54.71%，且缺乏適當減壓輔助床墊及工具。專案小組運用腦力激盪法擬定以下策略，包含：改善管路固定方式、皮膚照護策略、iPad拍照輔助紀錄、設計人形圖、構思創意作品、建構問題回報平台、汰舊換新減壓床墊及工具，加強跨團隊合作，並將此多元策略納入標準作業流程，確實追蹤檢討之，實施期間為2020年5月至2021年12月，壓力性損傷發生率由改善前1.40%降為0.48%，照護達成率由54.71%提升為94.43%，冀望醫療團隊對此議題有更深廣的了解與關注，更期許此成就能提供重症單位參考，進而提升醫療照護品質。 |
| 英文摘要 |
Up to 13-45.5% of critically ill patients in Intensive Care Unit (ICU) might suffer from pressure injury (PI) due to many factors such as hemodynamic instability, complex chronical disease, long-term immobility, impaired consciousness, malnutrition, and the vasopressors. PIs not only cause enormous pain for the patients, but also aggravate the morbidity, prolong hospitalization, deplete scarce medical resources, and even increase mortality rate. Therefore, preventing PIs must be viewed as a priority issue in ICU. Most PIs are preventable if appropriate measures are implemented. Originally, the incidence rate of PIs in ICU was 1.40%, and our PI care achievement rate was only 54.71%. The SWOT analysis revealed shortages of nurses’ cognition and deficiency of prevention care in pressure injury. Hence, an ad hoc task force was organized to rectify it by means of in-service training and divergent thinking skill (e.g., brainstorming, creative thinking) to generate possible solutions. In the technical aspect, the pressure-relief mattress and protective-devices were designed to protect against pressure injury, nasal cannulas and catheter, and tubes were properly rearranged to help soothe chafed skin. Human figure mapping, creative products development, and the checklist of comprehensive skin assessment were integrated into the normal workflow. Clinical handover was assisted with iPad photos. In addition, for experience sharing, we initiated an intranet chatroom to report and discuss special cases. Our field observation result indicated that our PI care achievement rate raised to 94.43% in December 2021. The average incidence of PI dropped to 0.48%. Through teamwork and many improvements, we have significantly reduced the incidence of PI. Since our clinical personnel have more self-confidence, enhanced PI nursing skills and better nursing quality, we indeed elevated the achievement rate of PI care, by virtue of the comprehensive skin assessment checklist. Our accomplishments, as stated above, may serve as a reference for other unit. |
| 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 |
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