運用實證軟膏防護和照護檢核表降低加護病房病人失禁性皮膚炎發生率

Empirical Protective Ointment and a Care Checklist Reduced ICU Patients for Incontinence-associated Dermatitis

李玉雯(Yu-Wen Lee) ； 林召倩(Chao-Chin Lin)

《源遠護理》 9卷2期 (2015/06) Pp. 55-64

https://doi.org/10.6530/YYN/2015.3.05

摘要

失禁性皮膚炎為重症單位常見皮膚破損原因之一，本單位2012年1-6月失禁性皮膚炎發生率為34.6%有偏高情形，因此護理人員能儘早評估和提供適當照護措施，是非常重要的。發生此問題主要原因為：無三班追蹤、照護方式不一致、無照護評估檢核表、無在職教育、不清楚失禁性皮膚炎的高危險群及軟膏使用時機。解決方案包括：訂定「高危險失禁性皮膚炎病患照護檢核表」、高危險失禁性皮膚炎照護流程及舉辦教育訓練，可落實評估和追蹤，並提升護理人員對失禁性皮膚炎的認知和照護技巧達一致性。執行本專案後失禁性皮膚炎發生率降至21.5%，達本專案目的。未來可推廣到各病房，以降低住院病人失禁性皮膚炎發生率。

關鍵字

失禁性皮膚炎 ； 軟膏防護 ； 照護檢核表 ； 發生率

並列摘要

Incontinence-associated dermatitis is common skin damage in intensive care units. The incidence of the studied unit from January to June 2012 was 34.6% and required prompt improvement interventions. Deficiencies noted were lack of nursing follow-up among three shifts, inconsistent care, lack of a standardized assessment checklist, lack of staff training, lack of recognition of high-risk population, and when to use skin protective ointment. Resolutions included establishing a checklist for ＂high risk for incontinence-associated dermatitis patient care,＂ a flow chart outlining the care process, staff education and training, an evaluation and tracking program, and enhancing caregiver's cognitive and care skills for incontinence-dermatitis. The incidence reduced to 21.5%. The goal is to extend this project to all intensive care units to reduce incidence of incontinence-associated dermatitis.

並列關鍵字

incontinence-associated dermatitis ； protective ointment ； care checklist ； incidence

參考文獻

Bliss, D. Z., Zehrer, C., Savik, K., Smith, G., & Hed-blom, E. (2007). An economic evaluation of four skin damage prevention regimens in nursing home residents with incontinence: Economics of skin damage prevention. Journal of Wound Ostomy & Continence Nursing, 34(2), 143-152. doi:10.1097/01.WON.0000264825.03485.40

Bliss, D. Z., Savik, K., Thorson, M. A. L., Ehman, S. J., Lebak, K., & Beilman, G. (2011). Incon-tinence-associated dermatitis in critically ill adults: Time to development, severity, and risk factors. Journal of Wound Ostomy & Conti-nence Nursing, 38(4), 433-445. doi:10.1097/WON.0b013e318220b703

Heimall, L. M., Storey, B., Stellar, J. J., & Davis, K. F. (2012). Beginning at the bottom: Evi-dence-based care of diaper dermatitis. MCN-the American Journal of Maternal-Child Nurs-ing, 37(1), 10-16. doi:10.1097/NMC.0b013e31823850ea.

Junkin, J., & Selekof, J. L. (2007). Prevalence of incontinence and associated skin injury in the acute care inpatient. Journal of Wound Ostomy and Continence Nursing, 34(3), 260-269. doi:10.1097/01.WON.0000270820.91694.1f

Junkin, J., & Selekof, J. L. (2008). Beyond “diaper rash”: Incontinence-associated dermatitis: Does it have you seeing red? Nursing, 38 (Suppl 11), 1-10. doi:10.1097/01.NURSE.0000341725.55531.e2.