降低綜合科加護病房壓傷發生率之改善專案

A Project of Reducing the incidence of pressure injury in the comprehensive intensive care unit

陳宜蓁(Yi-Jhen Chen) ； 劉亞璇(Ya-Syuan Liou) ； 楊怡君(Yi-Chun Yang) ； 呂麗戎(Li-Jung Lu) ； 李碧月(Pi-Yueh Lee)

《安泰醫護雜誌》 25卷2期 (2019/12) Pp. 47-61

摘要

背景：財團法人醫院評鑑暨醫療品質策進會將壓傷列入臨床照護重要品質指標，顯見壓傷它是醫療照護重要議題。單位2015年壓傷發生率為0.59％，相較同儕年平均值0.22%，高出許多，故成立專案改善小組，期望將壓傷發生率由0.59%降為0.20%。方法與結果：經臨床現況分析查檢後確立問題為：翻身擺位不正確、翻身未落實執行、沒有適當翻身輔助物、壓傷照護認知不足、未制訂壓傷分級照護標準及缺乏翻身技巧在職教育訓練。藉由文獻查證及團隊討論後，擬定在職教育、改良翻身輔助用物、設計翻身口訣及壓傷標記圖卡、制訂壓傷分級照護標準與成立壓傷照護種子等相關措施並落實稽核後，壓傷發生率由0.59%降至0.19%。結論：期望藉此本專案提供相關照護單位參考，擴大推廣至其他單位共同提升病人護理照護品質。

關鍵字

加護病房 ； 壓傷 ； 發生率

並列摘要

Background: The Joint Commission of Taiwan has included ＂pressure injury＂ as an important quality indicator of clinical care. It clearly shows that pressure injury is an important issue in medical care. The incidence of pressure injury in our intensive care unit was 0.59% in 2015, which was much higher than the annual average rate (0.22%) in peer units of other hospital .Purpose: A quality improvement project was performed in order to reduce the pressure injury rate from 0.59% to 0.20%. Methods and Results: Through the evaluation and analysis of clinical situations, the problems were identified as followed: improper or incomplete turning and positioning, shortage of proper aiding devices, inadequate knowledge of ulcer pressure and ulcer care, failure to draw up standards for staged pressure injury care, and lack of On-the-job educational training of positioning techniques. In addition, we have performed literature review and team discussion. The intervention focused on implementing maneuvers was performed to prevent the pressure injury. These maneuvers included: formulated the on-the-job educational training, improved aiding devices, designed mnemonic formulas and marking cards, established standards for staged pressure injury care and organized a group of seed staff. After implementation and audit for two years, our results depicted that the incidence rate decreased significantly from 0.59% to 0.19%. Conclusion: This study demonstrated that multiple strategies and consistent attention may contribute to the decrease in the pressure injury rates. If our experience can be expand and promote to other ICU, the quality of patient care especially the prevention or reduction of pressure injury may be feasible.

並列關鍵字

intensive care unit ； pressure injury ； incidence rate