運用跨團隊照護模式降低失禁性皮膚炎發生率之方案

Reducing the Incidence of Incontinence-Associated Dermatitis (IAD) Using Interprofessional Practice

10.6692/KJN.202404_41(1).0005

鄭雅方(Ya-Fang Cheng)；蘇郁婷(Yu-Ting Su)；江慈慧(Tsz-Huei Jiang)；鄭碧芬(Pi-Fen Cheng)；陳繪竹(Hui-Zhu Chen)

失禁性皮膚炎 ； 跨團隊照護 ； 皮膚照護模式 ； incontinence associated dermatitis (IAD) ； interprofessional practice ； skin care

高雄護理雜誌

41卷1期（2024 / 04 / 01）

61 - 74

繁體中文;英文

失禁性皮膚炎為壓力性損傷高危險因子，2020年4～5月本單位壓力性損傷發生率高於閾值，分析發現於尾薦骨處發生壓力性損傷者於2～3週前即有失禁性皮膚炎。探究原因為肥胖者皮膚皺褶深不易清洗、使用Penicillin抗生素、腹瀉≧3次／日、使用高滲透壓管灌配方；護理師不熟悉會陰部皮膚狀況評估量表、不知道失禁性皮膚炎照護方式；醫師不會主動評估病人腹瀉原因；無跨團隊預防失禁性皮膚炎照護計畫、缺乏相關在職教育。故2020/9/1至2021/8/31，介入教育訓練、制定「Bristol大便型態分類與照護」海報、啟動跨團隊預防失禁性皮膚炎照護計畫。改善後失禁性皮膚炎發生率由25.7%降至9.9%，尾薦骨處未再發生壓力性損傷，並將失禁性皮膚炎照護模式推展至居家照護此為對護理之貢獻。

Incontinence-associated dermatitis (IAD) is a high risk factor for pressure injury. From April to May 2020, the PI incidence rate of the patients in our unit was higher than the threshold. The patients with sacral and coccygeal pressure injuries developed IAD within 2 to 3 weeks. The reasons for this increased incidence rate were: the obese patient, who had deep skin folds that were difficult to clean, took Penicillin antibiotics, had diarrhea 3 times or more a day, and used high-osmotic pressure tube feeding formula; the nurses were not familiar with progressive achievement test scale, and did not know the care strategies for IAD patients; the physicians did not take the initiative to find out the cause of diarrhea of the patients; there was no interprofessional IAD prevention and care plan, and there was a lack of the relevant in-service education. From September 1, 2020 to August 31, 2021, the Bristol Stool Scale and Care poster was prepared, and an interprofessional IAD prevention and care plan was launched. The improvement was shown when the incidence rate of IAD of the patient decreased from 25.7% to 9.9%; PI did not occur over the patient's sacral and coccygeal area; and the IAD care model was extended to home care-a contribution to care strategies.

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