降低加護病房非計劃性氣管內管拔管之改善專案

A MAJOR WAY FOR REDUCING UNPLANNED ENDOTRACHEAL EXTUBATION IN AN INTENSIVE CARE UNIT

涂晟暘(Cheng-Yang Tu) ； 曾怡樺(Yi-Hua Tseng) ； 李誼柔(Yi-Jou Lee) ； 劉雅真(Ya-Chen Liu) ； 陳素惠(Su-Hui Chen) ； 李麗紅(Li-Hung Lee)

《秀傳醫學雜誌》 20卷1期 (2021/06) Pp. 1-7

https://doi.org/10.3966/156104972021062001001

摘要

管路異常事件之非計劃性氣管內管拔管現象一直是醫療照護上的重要課題，若不幸發生易造成病人二度傷害，最嚴重甚至死亡。統計本單位2016年1月至8月非計劃性氣管內管拔管率為0.69％，高於前一年度。經現況分析後，確立問題為：（1）未正確執行約束，（2）未設有鎮靜或止痛處理流程及（3）不清楚鎮靜或止痛藥的使用方式與注意事項。經專案小組擬定解決方案包括：修訂鎮靜疼痛評估表單、制定鎮靜止痛藥物用法及注意事項、修訂約束標準流程、規劃在職教育等措施。專案實施後，非計劃性氣管內管拔管率降至0.28％。本專案的成果顯示，藉由持續性的教育訓練、標準化設立、能夠提升團隊共識及照護技能，進而降低非計劃性氣管內管拔管率，達到提升病人安全與提高照護品質的目的。

關鍵字

護理專案 ； 約束 ； 非計劃性拔管

並列摘要

Unplanned endotracheal extubation causes discomfort to patients and can result in death. From January to August 2016, 0.69% of endotracheal extubations rate in the case unit were unplanned, which was higher than the figure for the previous year. Current problems are (1) inappropriate restraints, (2) lack of protocols for sedatives or analgesics and (3) a lack of knowledge with regard to sedatives or analgesics. This project proposes a revised a pain assessment form to establish criteria for the use of sedative analgesics, a list of precautions when using sedative analgesics as a revision to the standard procedure for physical restraint and a schedule for in-service education. After this project, the rate for unplanned endotracheal extubation decreased from 0.69% to 0.28%. The results show that continuous education and training, standardization, team consensus and increased care skills reduce the number of unplanned endotracheal extubations and increases patient safety and care quality.

並列關鍵字

Nursing project ； Restraints ； Unplanned extubation