- 期刊
非計畫性拔除氣管內管之改善專案
A projects of improve Unplanned endotracheal tube extubation
摘要
近年來病人安全的議題受到世界各國的重視，非計畫性拔除氣管內管為品管重要指標之一，2016年1－6月監測統計發現，非計畫性拔除氣管內管的情況偏高，嚴重影響團隊士氣。本專案目的在降低重症病房非計畫性拔除氣管內管率及建立有效預防的改善方案。經現況發現：保護性約束技術及氣管內管固定標準不一致，未適時評估予鎮靜止痛劑使用以減輕不適，缺乏有效團隊溝通。改善方案包括「修訂保護性約束技術標準及氣管內管固定標準」、運用跨團隊「實施止痛鎮靜劑使用規範」、「制訂氣管內管移除規範」等，評值2017年1－6月非計畫性拔除氣管內管率從改善前的0.44%降至0.14%，顯示本專案所提的解決方案有助於降低非計畫性拔除氣管內管。
並列摘要
The issue regarding patients' safety is receiving more attention recently around the world. Unplanned endotracheal tube extubation (UEE) is an important indication of patients' safety. Besides the relation of UEE to airway damage, bronchospasm, difficulty of reintubation, and patients' safety, there are also extended length of hospital stay, increases of medical cost and loading of medical staff. According to the surveillance record of our unit between January to June in 2017, when the rate of UEE is higher, UEE reduces the staff's workload. This study aims to decrease the UEE rate in ICU and to establish effective prevention strategy. The causes of UEE include different Standard Operating Procedure (SOP) for protective restriction and fixation of endotracheal tube, inefficient assessment of sedative and analgesic agents use, lack of effective team communication. The modified prevention strategy include revision of SOP of protective restriction and fixation of endotracheal tube, using team care based on the norm of sedatives and analgesics, and revision of the SOP for extubation. After we adapt the prevention strategies, the rate of UEE was lowered from 0.44% to 0.14%, which revealed our strategy being helpful for decreasing the UEE. We can use the strategies to maintain patients safe and hence promoting the quality of care.