降低頭頸癌病人術後鼻胃管自拔率

A Project to Reduce Rate of Deliberate Self-Extubation of Nasogastric Tube Among Postoperative Head and Neck Cancer Patients

郭楊卿(Yang-Ching Kuo)；李彥範(Yen-Fan, Lee)；曾貴萍(Kuei-Ping Tseng)；王琬詳(Wan-Hsiang Wang)

頭頸癌 ； 鼻胃管 ； 自拔率 ； head and neck cancers ； nasogastric tube ； self-extubation rate

志為護理-慈濟護理雜誌

17卷6期（2018 / 12 / 01）

71 - 81

繁體中文

頭頸癌病人術後會留置鼻胃管供給營養及避免感染發生。2012年1-2月因術後鼻胃管自拔率高達3.60%。專案小組以成功案例探討，導因確立為護理師依據病人需求所提供的指導重點只有13.33%，且對鼻胃管放置感受形容一致性只有23.96%。專案目的為降低鼻胃管自拔率至0.72%。改善措施為1.擬定及執行鼻胃管照護模式：(1)轉入當班指導重點(2)三班給予重點學習(3)有效的溝通回饋；2.正向鼓勵方式進行案例討論並修正照護模式3.修正護理指導單張。專案措施施行後，2012年9月～2013年8月自拔率降至0.57%。顯示此成功案例經驗探討改善方式，能有效降低頭頸癌病人術後鼻胃管自拔率。

Patients with head and neck cancers are often intubated with nasogastric tube after surgery for nutrition provision and infection prevention. The rate of deliberate self-extubation of nasogastric tube was 3.60% among patients after surgery in our hospital from January to February, 2012. By investigating cases of successful extubation, our team was able to identify the major factors behind the premature self-extubation: low rate of patient education delivered by nurses according to patients’ needs (only 13.33%), and low percentage of consistency in patients' descriptions of their experience after nasogastric intubation (23.96%). This project was aimed to reduce the self-extubation rate of nasogastric tube among patients with head and neck cancers to 0.72%. The nursing interventions included: 1. develop and implement nasogastric tube care model: (i) set the care model as a key point in the patient education shift routine, (ii) set the care model as a focal point for each shift, and (iii) establish effective communication and feedback; 2. encourage case discussions using positive feedback and revise care model accordingly; 3. revise patient education pamphlets. After the project was implemented, from Sept. 2012 to August 2013, the rate of deliberate self-extubation of nasogastric tube was reduced to 0.57%. This result indicates that our nasogastric tube care model is effective in reducing the rate of deliberate self-extubation of nasogastric tube among patients with head and neck cancers after surgery.

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