預防醫療器材導致壓瘡之品質改善研究

The Quality Improvement Research of Prevent Medical Device Related Pressure Ulcers

10.6299/JHA.2017.4.2.R9.81

葉旻姍(Yeh, Min-Shan)；王麒嘉(Wang, Qi-Jia)；廖淑貞(Liao, Shu-Chen)

非侵襲性正壓呼吸器 ； 醫療器材壓瘡 ； 壓瘡 ； noninvasive positive pressure ventilator ； medical device related pressure ulcer ； pressure ulcer

健康與建築雜誌

4卷2期（2017 / 06 / 01）

81 - 87

繁體中文

目的：運用持續性品質改善概念架構及步驟，進行保護性敷料裁剪標準化以降低醫療器材壓瘡之發生率。材料與方法：利用尺規板、矽膠泡棉敷料、人工皮及各式氧療設備（包含非侵襲性正壓呼吸器面罩、氧氣鼻導管、氧氣面罩及氣管內管等），以持續性品質改善概念架構，創新設計保護性敷料尺規裁剪板。結果：保護性敷料尺規裁剪板之創新及應用，可符合臨床照護需求，並具有(1)安全性：使用各種氧療設備可預防病人發生醫療器材壓瘡，降低壓瘡發生率。(2)實用性：護理師可簡易、快速上手操作，省時便利。(3)舒適性：因應病人臉型及使用之氧療設備做適當保護，可有效減輕面罩、管路壓迫之疼痛不適感，提升舒適度。結論/實務應用：保護性敷料尺規裁剪板創新應用，可有效預防醫療器材壓瘡，提升照護品質，亦可提升病人家屬及護理師之滿意度。護理師在使用之安全性、實用性、舒適性及預防壓瘡效果均達100%。壓瘡發生率自2014年1.02%下降至2015年0.29%，醫療器材壓瘡發生率由2014年0.45%下降至2015年0.09%，且壓瘡嚴重等級由二度減輕為一度。

Objects: Using the strategy of continuous quality improvement to promote the dressing cutting standardization and reduce the incidence of medical device related pressure ulcers. Methods: The concept of the strategy of continuous quality improvement in this plan is to modify ＂the process of protective dressing via the ruler cutting board＂. According to the shape of various types of oxygen therapy equipment (including noninvasive positive pressure ventilators mask, nasal cannula, oxygen mask and endotracheal tube), the suitable size of protective dressing (including silicone foam dressing or duoderm) is cut out via the ruler cutting board. Results: The innovation and application of the method via ruler cutting board for protective dressing can meet the needs of clinical care, and it have three characters: 1). Safety: prevent the occurrence of medical device related pressure ulcers and reduce the incidence of pressure sores under various types of oxygen therapy equipments. 2). Applicability: Easy operation for registered nurse, which is less time-consuming and more convenient. 3). Comfortable: suitable size between the patient’s face and the oxygen therapy equipment, which can effectively reduce the compression pain/discomfort from the mask or the tubing. Conclusions/Implications for Practice: The innovative applications of ruler cutting board for protective dressing can effectively prevent the medical device related pressure sores and improve the quality of care. There it enhance the satisfaction of patient's family and registered nurse. The satisfied outcome of safety, applicability, and comfortable can reach 100%, as well as the price and pressure ulcer prevention. The incidence of pressure ulcers decreased (1.02 % in 2014 to 0.29% in 2015). Medical device related pressure ulcers incidence rate dropped 20% (0.45% in 2014 to 0.09% in 2015), and the pressure ulcer degree ease from two to one.