降低加護病房氣管內管留置病人臉部皮膚撕裂傷發生率

Reduce Facial Skin Tear Incidence Rate of Endotracheal Tube Patients in ICU

吳淑偵(Shu-Chen Wu) ； 鄭春蘭(Chun-Lan Cheng) ； 廖懷琳(Huai-Lin Liao) ； 陳曉鈴(Hsiao-Ling Chen)

《志為護理-慈濟護理雜誌》 18卷2期 (2019/04) Pp. 74-84

摘要

背景：維持病人皮膚完整性是臨床照護重要品質指標，氣管內管留置病人一旦發生臉部皮膚撕裂傷易使氣管內管不好固定增加滑脫風險。本專案自2014年1月1日至5月31日經專案小組深入探討發現有：（1）標準未說明宜拉膠帶使用與皮膚保護之正確方式、（2）單位自行變更氣管內管固定方式、（3）親水性敷料造成皮膚浸潤其黏性物不易清除、（4）宜拉膠帶操作方式不正確、（5）氣管內管留置病人皮膚照護認知不足等問題。目的：降低氣管內管留置病人臉部皮膚撕裂傷發生率由16.8%降低至3.5%。解決方案：製定及推行氣管內管留置病人皮膚組合式照護流程，舉辦皮膚照護教育訓練與稽核。結果：專案推行後成功將氣管內管留置病人臉部皮膚撕裂傷發生率由16.8%降為3.4%。結論：本專案有效改善氣管內管留置病人臉部皮膚撕裂傷發生率，成功提升氣管內管留置病人皮膚照護品質；期望能行推廣至加護病房，嘉惠更多病人。

關鍵字

臉部皮膚撕裂傷 ； 氣管內管固定 ； 組合式照護

並列摘要

Background: Maintaining patient skin integrity is an important quality indicator in clinical care. Impaired facial skin integrity in intubated patients can increase the difficulty in securing endotracheal tube as well as the risk of tube slippage. The project was launched on January 1^(st) to May 31^(st), 2014. An in-depth investigation conducted by the project team revealed the following: 1) the SOP did not specify the correction use of elastic adhesive tape and skin protection; 2) the unit made unauthorized changes to endotracheal tube fixation method; 3) the gelatinous residue resulted from skin infiltration of hydrocolloid dressing is difficult to remove; 4) improper use of elastic adhesive tape; and 5) lacking skin care knowledge for intubated patients. Purpose: The goal of this project was to reduce the incidence rate of facial skin tear among intubated patients from 16.8% to 3.5%. Resolution: The Endotracheal Tube Skin Bundle Care procedure for intubated patients was produced and implemented, and skin care educational training and auditing were conducted. Result: After the program was implemented, the incidence rate of facial skin tear was successfully reduced from 16.8% to 3.4%. Conclusion: This program effectively improved the incidence rate of facial skin tear, and successfully increased the quality of skin care for intubated patients. We would like to advocate and implement the project in ICU in hope to benefit more intubated patients.

並列關鍵字

bundle care ； endotracheal tube fixation ； facial skin tear

參考文獻

戴如君、陳蕙茹、高玉玲(2014)・降低置放氣管內管病人皮膚撕裂傷發生率・源遠護理，8(3)，49-56。doi:10.6530/YYN/2014.C.06

Choi, Y. S., & Chae, Y. R. (2012). Effects of rotated endotracheal tube fixation method on unlanned extubation, oral mucosa and facial skin integrity in ICU patients. Journal of Korean Academy of Nursing, 42 (1), 116-124. doi:10.4040/jkan.2012.42.1.116

Cooper, D., Jones, S. L., & Currie, L. A. (2015). Against all odds: Preventing pressure ulcers in high-risk cardiac surgery patients. Critical Care Nursing, 35(5), 76-82. doi:10.4037/ccn2015434

McNichol, L., Lund, C., Rosen, T., & Gray, M. (2013). Medical adhesives and patient safety: State of the science. Journal of Wound Ostomy and Continence Nursing, 40 (4), 365-380. doi:10.1097/NOR.0b013e3182a39caf

McTigue, T., D’Andrea, S., Mounoz, J., & Forrester, D. A. (2009). Efficacy of a skin tear education program. Journal of Wound Ostomy Continence Nursing, 36 (5), 486-492. doi: 10.1097/WON.0b013e3181b35ebd