- 期刊
降低肝病病人藥物相關失禁性皮膚炎發生率
Reduce Incidence of Drug-related Incontinence Associated Dermatitis in the Liver Disease Patients
摘要
背景：肝衰竭、肝硬化合併肝腎症候群病人使用Lactulose或Terlipressin易造成失禁性皮膚炎（以下簡稱IAD），2019年1～5月因藥物相關IAD發生率高達37.1%，主要原因：護理師無預防IAD指引可供遵循、護理師未於給藥前提供預防IAD指導、缺乏預防IAD衛教單張、預防IAD方式不正確、未及時使用皮膚保護用品。目標：肝病病人藥物相關IAD發生率由37.1%降至19%。介入方案：經由及早篩選高危IAD族群、設計分期圖尺、高危提醒卡、衛教單張，並制定標準照護流程，同時舉辦教育訓練提升護理師照護認知，在給藥前提供預防性保護措施，並庫備皮膚清潔、防護用品以供及時使用。結果：藥物相關IAD發生率降至17.8%；IAD第2期占比降至12.5%；花費29%治療IAD的費用預防可能產生的IAD，有顯著的成本效益。護理師依照IAD照護流程的執行率達100%。結論：提升護理師照護認知並制訂標準IAD照護流程，是降低藥物相關IAD發生率之有效方法。
並列摘要
Patients with liver conditions, such as liver failure, cirrhosis, or hepatorenal syndrome, who use lactulose and terlipressin are highly susceptible to incontinence-associated dermatitis (IAD). The incidence of drug-related IAD was 37% between January and May, 2019 due to a lack of standard operating procedures for IAD nursing care, preventive measures and health education before the distribution of medicines to patients, and timely use of skin protection products. Nurses applying incorrect IAD prevention measures may also be responsible. We recommend designing staging charts and cards reminding nurses of high-risk factors as well as implementing health education. In addition, standard operating procedures should be developed, and educational training programs should be conducted to improve the nursing care knowledge of the nursing staff. Through early screening for patients at high risk for IAD, preventive measures can be implemented for such patients before medication administration. In addition, skin-cleansing and protective equipment should be stored in a manner that facilitates timely use. The incidence of drug-related IAD in patients with liver disease decreased from 37.1% to 19%, indicating that the project goal had been achieved. The incidence of drug-related IAD decreased to 17.8%. The proportion of patients developing stage 2 IAD decreased to 12.5%. This project was cost-effective, with only 29% of the cost spent on preventing possible IAD medical expenses. In this project, all nurses performed IAD care. In sum, this project helped reduce the incidence of drug-related IAD by standardizing skin care procedures and improving nurses' awareness of IAD care.