降低食道癌病人經皮內視鏡胃造口皮膚損傷發生率之方案

食道癌病人常合併吞嚥困難造成營養不良，需要在手術切除腫瘤前，先置放經皮內視鏡胃造口管，做為放射線及化學治療期間營養補充的管道，當經皮內視鏡胃造口發生皮膚損傷時，將無法作為提供營養的管道，造成身體不適影響治療甚至延長住院天數，可見胃造口照護的重要性。專案小組發現本院食道癌病人，因為缺乏胃造口照護標準、護理人員教導的換藥方式不一致、主要照顧者不知胃造口的重要性，常發生胃造口皮膚損傷的合併症，故引發改善動機。經過專案改善措施，製訂胃造口照護標準作業書、製作換藥查檢表、舉辦教育課程、製作衛教單張及多媒體光碟、應用照護模具衛教家屬等，使經皮內視鏡胃造口皮膚損傷發生率由42.3%降至3.3%，並持續品質指標監測，追蹤五年成效維持零發生率，期望藉此專案分享，提升護理人員對食道癌病人經皮內視鏡胃造口的照護品質。

關鍵字

食道癌；經皮內視鏡胃造口；皮膚損傷

並列摘要

Patients with esophageal cancer often suffer from malnutrition caused by dysphagia. It is necessary to insert a percutaneous endoscopic gastrostomy tube before removing the tumor as an alternative treatment for nutrition supplement during radiotherapy and chemotherapy. When skin damage occurs from the poor care of the percutaneous endoscopic gastrostomy, it will not be suitable for providing enteral nutrition, as it causes physical discomfort and prolong hospitalization. The project team found that patients with esophageal cancer in our hospital had poor percutaneous endoscopic gastrostomy care standards,and that there was inconsistency between the teaching given to nurses and the informal caregivers in the steps needed in changing dressings. The incidence of skin damage decreased from 42.3% to3.3% after the quality care control project had been implemented as follows: the standard operation procedure for percutaneous endoscopic gastrostomy care, examining checklists for methods used to change dressings, in-service educational courses, making multimedia CDs and printing health education leaflets, applying percutaneous endoscopic gastrostomy care models for teaching family members. The five-year longitudinal effect was maintained at zero. It is expected to share this project to improve the care quality of patients with esophageal cancer who have percutaneous endoscopic gastrostomy.

並列關鍵字

Esophageal cancer ； Percutaneous endoscopic gastrostomy(PEG) ； Skin damage

國際替代計量

降低食道癌病人經皮內視鏡胃造口皮膚損傷發生率之方案

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