- 期刊
提升加護病房口咽氣管內管留置病人口腔清潔之正確性
Improving the Accuracy of the ICU Oropharynx Trachea Tube Intubating Patients' Oral Hygiene
摘要
加護病房之重症患者大多為維持生命保持呼吸道通暢而留有氣管內管，因口腔需持續張開，易有口乾不適情形甚而導致口腔黏膜改變、口腔炎症、潰瘍、口臭等狀況，因此提供正確口腔清潔護理是非常重要。本單位氣管內管留置人數佔78%，入院3－6天後病患口腔黏膜完整性僅達44.4%；且現況發現護理人員執行口腔護理技術正確性僅達66.3%。由於有效的口腔護理不僅可增進病人口腔舒適、維持口腔黏膜完整，更可預防嚴重院內感染。故組成專案小組擬定解決方案：（1）修訂口腔護理照護常規（2）安排口腔護理訓練（3）製作口腔護理提醒語（4）更改口腔清潔工具（5）研發口咽氣管內管固定便利夾（6）牙菌斑檢測口腔清潔度。改善後口腔護理技術正確性達改善後口腔護理技術正確性應為98.8（98.76），牙菌斑級數四、五級降至0%，口腔黏膜完整性提升至91.2%。本專案運用相關護理改善措施，使病人改善口腔黏膜完整性，提昇舒適感，更提供安全及自主的優質服務。
並列摘要
Trauma patients in ICU are often intubated to maintain a patent airway, yet orotracheal intubated patients frequently develop oral inflammation, mucosal lesions, ulcers, and bad breath due to persisted mouth opening and the resultant dryness. Provision of adequate oral care to intubated patients could eliminate bad breath and reduces oral mucosal damage. In an ICU in a northern Taiwan medical center, delivery of accurate oral hygiene nursing was reported to only 66.3% of cases. Measures to improve this suboptimal condition were introduced, including (1) revising oral hygiene nursing routine; (2) arranging oral care training program; (3) increasing display of oral care rhyming verse; (4) changing oral cleaning tools; (5) utilizing new orotracheal tube fixer; and (6) introducing plaque grading system. These measures brought about an improvement in accurate oral hygiene nursing delivery to 98.6%, with no patients developing grade IV or V dental plaques. Of all the orotracheally-intubated patients, 91.2% had healthy oral mucosa. These measures have thus been proven effective in improving the quality in oral hygiene nursing in the critically ill patients.