提升肺炎住院病人初始照護穩定率

肺炎隨著人口老化對健康的影響更顯重要，本單位肺炎住院病人在配合抗生素治療後，觀察照顧者執行背部叩擊的方式、頻率及持續時間皆有所缺失，故引發小組執行本改善專案之動機。經現況分析發現初始照護穩定率僅42.85%，其中包括病人無力肺擴張（78.26%）、痰液排除困難（78.26%）；照顧者執行痰液排除活動不完整（85.00%）、執行口腔清潔不佳（92.30%）；護理師未執行肺炎相關護理指導（70.00%）；護理指導工具便利性（66.66%）及通用性（93.93%）不足；胸腔照護醫囑開立不完整（100%）。經文獻查證及團隊討論後，於2020年9月至2021年3月期間執行本改善專案，經由開發個人化肺炎照護APP及護照、修正肺炎照護規範，以提供及時且便利的照護模式。肺炎住院病人初始照護穩定率由42.85%提升至73.68%，持續追蹤至4月均達專案目標71.42%以上。個人化肺炎照護APP已平行推廣至其他單位，提升肺炎照護品質。

關鍵字

肺炎；初始照護穩定；胸部物理治療；智慧醫療

並列摘要

Pneumonia can strongly affect health, particularly for older adults. After inpatients with pneumonia in our unit are treated with antibiotics, their initial care often remains unstable (48.25%). Most clinical care provided to patients with pneumonia is based on chest percussion assessments, which, research has indicated, caregivers tend to perform incorrectly. For this reason, the present project was launched. This project revealed that most of the studied patients could not expand their lungs (78.26%) and found removing sputum difficult (78.26%), that caregivers performed chest percussion assessments (85.00%) and oral cleaning poorly (92.30%), that nurses didn't give pneumonia-related nursing guidance (70.00%), that the amount of nursing tools were insufficient (66.66%), and that thoracic care orders were not appropriately issued (100%). All of these factors contributed to the instability in initial care. After a literature review and a team discussion, a personalized pneumonia care app and passport were developed, pneumonia care norms were revised, and a convenient care model was established. The stability rate for inpatients with pneumonia increased from 42.85% to 73.68% from July to August, 2020 to January, 2021, and continued reaching above the project target of 71.42% until April. The care bundle combined with the mobile app has since been expanded to other parallel units to improve the quality of pneumonia care.

並列關鍵字

pneumonia ； stability of initial care ； chest physiotherapy ； eHealth

參考文獻

沈季香、楊麗玉(2020)．探討胸腔物理治療對肺部感染病人住院天數、醫療費用之影響．護理雜誌，67(2)，58-64。

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