降低血液腫瘤病房壓力性損傷之發生密度

Reducing the Incident Density of Pressure Injury in Hematology-Oncology Wards

周幸儀(Hsing-Yi Chou) ； 謝秀祝(Shiouh-Chu Shieh) ； 盧婉菁(Wan-Jing Lu) ； 陳瑞儀(Jui-Yi Chen) ； 鄭之勛(Jih-Shuin Jerng) ； 高秀娥(Hsiu-O Kao)

《台灣醫學》 24卷3期 (2020/05) Pp. 324-334

https://doi.org/10.6320/FJM.202005_24(3).0012

摘要

血液腫瘤科病人因化療或骨髓移植後免疫抑制，易因體能虛弱臥床時間長，單位壓力性損傷發生密度由2013年0.17％上升至2014年0.30％，故期望藉專案推動有效降低壓力性損傷發生密度。分析導因為：（1）護理師對壓力性損傷護理認知不足；（2）護理師壓力性損傷分級判定能力不足；（3）護理師壓力性損傷照護執行不足；（4）本單位防壓輔具設備不足。經加強在職教育及培育種子人員，提升護理師對壓力性損傷預防相關認知及操作能力，建立壓力性損傷照護查核機制，即時介入適當的防壓措施輔具，利用翻身擺位圖片單張或影片，提升指導效能，並善用跨領域團隊合作資源，壓力性損傷發生密度可由改善前平均0.30％下降至0.12％，可達目標值且效果維持成效良好，有助於提升壓力性損傷護理品質。

關鍵字

血液腫瘤 ； 壓力性損傷

並列摘要

Patients at the hematology-oncology wards are prone to develop pressure injury because of frailty due to prolonged bed-ridden status, which was a result of immunosuppression by chemotherapy or bone marrow transplantation. In out unit, the density of pressure injury increased from 0.17% in 2013 to 0.30% in 2014; therefore, we thus expected this project could effectively reduce the occurrence of stress injury. Causes of this situation included: (1) A lack of awareness and knowledge regarding pressure injury. (2) Insufficient skills for assessing and staging pressure injury. (3) Poor execution of necessary procedures for preventing pressure injury. (4) Inadequate injury-preventing devices. Strategies of improvement included intensification of on-job training for staff members and trainers, enhancement of knowledge and skills related to injury prevention, auditing of injury-preventing practices, timely intervention with pressure-preventing devices, improvement of education efficacy by applying relevant diagrams, pictures and videos, and employment of multidisciplinary team resource management. These strategies reduced the density of pressure injury from 0.30% to 0.12%, which reached the goal and was well sustained. We concluded that our program provides evidence and useful guidance to enhance the quality of nursing care for the prevention of pressure injury.

並列關鍵字

hematology-oncology ； pressure injury

參考文獻

林文綾、曾健華、鍾宜真等：運用皮膚照護群組模式降低肺癌住院病人壓力性損傷發生密度之成效。護理雜誌 2014;61:85-94。[Lin WL, Tseng CH, Chung YJ, et al. The effectiveness of care bundles in maintaining the skin integrity and reducing the incidence density of pressure ulcers in lung cancer inpatients. The Journal of Nursing 2014;61:85-94.]

Qaseem A, Mir TP, Starkey M, et al. Risk assessment and prevention of pressure ulcers: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2015;162:359-69.

Adibelli S, Korkmaz F. Pressure injury risk assessment in intensive care units: Comparison of the reliability and predictive validity of the Braden and Jackson/Cubbin Scales. J Clin Nurs 2019;28:4595-605.

Aygor HE, Sahin S, Sozen E, et al. Features of pressure ulcers in hospitalized older adults. Advances Skin Wound Care 2014;27:122-6.

Litchford MD, Dorner B, Posthauer ME. Malnutrition as a precursor of pressure ulcers. Advances In Wound Care (New Rochelle) 2014; 3:54-63.