改善鼻胃管照護模式以降低滑管發生率專案

Project to Reduce the Incidence Rate of Nasogastric Tube Slippage in the Gastroenterology Ward

塗勝翔(Sheng-Hsiang Tu)；溫明寰(Ming-Huan Wen)；許雅婷(Ya-Ting Hsu)；林承萱(Chen-Hsuan Lin)；林小玲(Shir-Ling Lin)

鼻胃管照護 ； 滑管 ； Nasogastric tube care ； Nasogastric tube slippage

嘉基護理

17卷2期（2017 / 12 / 01）

13 - 24

繁體中文

背景：鼻胃管常用來提供腸道營養、給藥及引流胃容物，滑管時會影響照護品質，重置過程不僅造成病人不適感，亦增加吸入性肺炎風險。專案病房統計2015年1月～7月間，鼻胃管滑脫共25件，滑管率0.298%，高於同期全院一般病房發生率0.021%。目的：改善鼻胃管照護模式以降低滑管發生率。解決方案：專案時間為2015年8月～2016年7月，分析要因：疾病因素導致意識不清、照顧者對預防拔管警覺性不足、約束及管路固定方式不正確。措施：矯正造成意識不清躁動不安原因、增加雙重管路固定、加強照顧者預防滑管護理指導、制定約束標準、鼻胃管護理照護完整性及稽核辦法，建立專科病房鼻胃管照護模式，使照護達一致性。結果：成效評值：統計2016年1月～7月管路滑脫共5件，滑管發生率為0.060%，管路照護完整率提升至100%，達專案目的。討論：本專案從病人、照顧者、約束與固定方法等方面介入，建構鼻胃管照護一致性，降低鼻胃管滑脫發生率，現已將此模式列入病房新進人員3個月內需完成學習的項目，也建議未來能推廣使用。

Background: Nasogastric tube (NG) is usually used to provide enteral nutrition, administration of drug and drainage of gastric contents. Sliding tube will affect the quality of care, because the reinsertion process will increase the patient’s discomfort and the risk of aspiration pneumonia. From January to July 2015, a total of 25 NG slippage issues were reported in a Gastroenterology ward with the incidence rate of 0.298%, which was higher than general hospital ward rate of 0.021%. Aim: To reduce the incidence rate of NG slippage in the Gastroenterology ward. Method: The risk factors to induce NG slippage included: (1) the patient with disturbance of consciousness, (2) caregivers without extubation alert, (3) inappropriate restraint and (4) incorrect catheter fixation. This strategies undertaken to avoid NG slippage by our ward included: (1) to rectify the cause of agitation, (2) emphasize catheter fixation, (3) strengthen nursing instruction for caregivers, (4) develop standards of constraint, (5) develop NG care integrity and audit. Results: After above strategies, there are totally 5 newly NG slippage issues were reported in January-July 2016, the incidence rate was significantly reduced from 0.298% to 0.060%. NG care integrity rate was improved up to 100% with consistency. Conclusion: This project involves patients, caregivers, restraints and fixation methods to construct NG care consistency, and reduce the incidence rate of NG slippage. The new employees need to learn this project with 3 months. Furthermore, due to its efficacy, it would be recommended expanding this NG care project to other hospitals or institution.

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