提升腦中風病房護理人員執行吞嚥功能評估正確率之專案改善

Interventions for Enhancing the Accuracy of Swallowing Function Assessment among Medical Staff in the Stroke Unit

莊雅文(Chuang ya-wen)；湯雅筑(Tang ya-zhu)；羅宇婷(Lo Yu-Ting)；林恩如(Lin En-Zu)；廖惠娟(Liao Hui-chuan)

腦中風 ； 吞嚥功能評估 ； stroke ； swallowing function assessment

嘉基護理

18卷2期（2018 / 12 / 01）

32 - 42

繁體中文

腦中風病房護理同仁正確執行吞嚥功能評估，可即時了解病人吞嚥情形，有效預防嗆咳，預防因吞嚥困難所致之合併症。專案目的，旨在提升護理人員，執行吞嚥功能評估正確率。經現況分析後確認：(1)缺乏執行吞嚥功能評估作業標準；(2)缺乏吞嚥功能評估教育訓練；(3)缺乏吞嚥功能評估工具；(4)缺乏吞嚥功能評估指導資源。經實施對策：(1)制訂吞嚥功能評估作業；(2)舉辦在職教育；(3)訂定吞嚥功能評估表；(4)製作吞嚥功能評估教學光碟、指導手冊；(5)列入病房常規品管稽核後，監測同仁吞嚥功能評估認知率達100%、吞嚥功能評估技能正確率自47.5%上升至94.1%，護理同仁執行吞嚥功能評估正確性已顯著提升。透過專案對策介入，可提升吞嚥功能評估技能正確率，降低病人吸入性肺炎風險，更可提升專業技能與工作成就感。

Accurate assessment of patients' swallowing function enables medical staff in stroke units to instantly appraise patients' swallowing ability and thus effectively prevent coughing or other complications induced by swallowing difficulty. The purpose of this study was to enhance medical staff's accuracy in swallowing function assessment. An analysis of the current situation revealed that medical stroke wards lack (1) standard operating procedures, (2) training programs, (3) instruments, and (4) guidelines for swallowing function assessment. To address the situation, five measures were introduced, namely (1) the establishment of standard operating procedures for swallowing function assessment, (2) the implementation of on-the-job training, (3) the creation of a swallowing function assessment form, (4) the production of instructional discs and manuals for swallowing function assessment, and (5) the inclusion of swallowing function assessment into the ward's routine quality audit. Subsequently, medical staff achieved a recognition rate of 100% for swallowing function assessment, and assessment accuracy rose from 47.5% to 94.1%, which represented a significant improvement in the capability of accurately assessing patients' swallowing function. Therefore, the interventions introduced by this study were effective in enhancing the accuracy of swallowing function assessment among medical staff and reducing patients' risk of sustaining aspiration pneumonia. Moreover, the interventions were effective in improving medical staff's professional expertise and sense of accomplishment.

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