降低內科病房非計畫性鼻胃管自拔改善專案

鼻胃管主要作為病人營養支持路徑、給藥治療與引流減壓。本單位為一般醫學內科，2016年共發生23件鼻胃管自拔事件，為全院管路異常事件高發生單位，且單月發生率高達1.6%，受院方重視也影響士氣，引發改善動機。專案小組成立目的為降低非計畫性鼻胃管自拔發生率0.9%，現況分析歸納問題包括：（一）缺乏辦理鼻胃管及約束照護訓練課程；（二）缺乏專屬鼻胃管照護標準；（三）護理人員不熟悉鼻胃管及身體約束照護標準內容；（四）缺乏鼻胃管照護稽核制度。介入措施包括：舉辦二場鼻胃管照護訓練課程、實際示範正確操作約束、落實鼻胃管自拔照護方案，運用髮帽以預防管路垂掉與製作榮譽榜，增加人員的信心，有效降低鼻胃管自拔平均發生率至0.1%，追蹤成效維持良好，更顯示措施有效性，增進管路安全。

關鍵字

非計劃性；鼻胃管；自拔

並列摘要

The nasogastric tube is mainly used for patient's nutritional support route, medication treatment and drainage decompression. The medical internal ward had 23 events of deliberate self-extubation nasogastric tube in 2016, which was higher than other wards in our hospital. The incidence rate also increased by 1.6% in a single month, triggering our team’s motivation to improve and promote the morale of colleagues; accordingly, the purpose of the project was to reduce the incidence of deliberate self-extubation nasogastric tube. We identified the major problems as being lack of nasogastric tube care training courses, lack of education to prevent nasogastric tube self-extubation, and lack of nasogastric tube care standards, whereby the nursing staff was not familiar with the nasogastric tube and body restraint care standards, as well as lack of knowledge concerning the nasogastric tube care audit system. The intervention included holding two nasogastric tube care training courses, demonstrating correct practical operation constraints, implementing a nasogastric tube self-extubation care plan, teaching use of a hair cap to prevent drop of nasogastric tube, and making an Honor Roll to increase personnel confidence. This intervention resulted in the incidence rate of deliberate self-extubation of nasogastric tube decreasing to 0.1%, and the tracking of performance illustrating effective maintenance, showing the effectiveness of the intervention and improved nasogastric tube safety.

並列關鍵字

deliberate ； nasogastric tube ； self-extubation

參考文獻

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詹琪文、全桂蘭、廖靜珠、胡月娟(2017)．重症病人身體約束照護指引的建立與成效評值．台灣急重症醫學雜誌，2(1)，10-21。https://doi.org/10.6142/VGHN.23.3.319

廖永澄、呂淑華(2014)．以實證探討鼻胃管灌食導致吸入性肺炎之預防措施．長期照護雜誌，18(2)，237-250。https://doi.org/10.6317/LTC.18.237

國際替代計量

降低內科病房非計畫性鼻胃管自拔改善專案

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