降低脊椎手術病人術中壓力性損傷發生率

壓力性損傷是護理照護敏感性指標，一旦發生不僅造成病人疼痛，甚至併發感染及提高死亡率，增加醫療照護成本。本單位2017年脊椎手術壓力性損傷發生率為16％，分析原因為無標準流程、未執行危險因子評估、照護認知不足、擺位與皮膚防護不完整、防護設備不足、手術時間長、術中翻身移動困難。期望藉由麻醉及手術護理組成照護團隊，共同研擬改善對策，提升手術照護品質。解決方案：製作脊椎手術擺位照護手冊、發展手術全期壓力性損傷風險評估工具及預防照護流程並資訊化、舉辦教育訓練及情境演練、使用皮膚防護設備及預防性減壓敷料、執行照護監測機制、運用站立會議即時回饋照護問題並研擬再對策。脊椎手術壓力性損傷發生率由改善前16％降至改善後3.6％，且後續效果維持良好。建議未來依手術科別擺位發展具各科特性之防護措施，期能全面降低手術室壓力性損傷發生率。

關鍵字

手術全期；脊椎手術；壓力性損傷

並列摘要

Pressure injury is one of the nurse-sensitive clinical indicators. Once occurring, it causes pain and discomfort, lead to complications such as infections, and increase mortality and healthcare costs. In 2017, the rate of pressure injury incidence of surgical spinal patients in the Unit was 16%. Based on the analysis, the reasons included the lack of standardized procedures, failure to perform risk assessment, insufficient knowledge and awareness of pressure injury prevention, incomplete positioning and skin protection, insufficient protective equipment, long operation time, and difficulty in turning over during the operation. It is hoped that anesthesia and surgical nursing staff will form a nursing team to jointly formulate improvement measures and improve the quality of surgical care. The solution developed by the Unit included: establishing standardized procedures for spine surgery positioning, developed a perioperative pressure injury risk assessment tool and prevention protocol and setting it in the nursing information system, organizing education training and performing simulation, using skin protection equipment and preventive decompression dressings, establishing a care audit system, and using daily huddle to discuss care problems in a timely manner and developing countermeasures. The incidence of pressure injury in spinal surgery decreased from 16% before improvement to 3.6% after improvement, and the follow-up effect remained good. It is recommended that in the future, each department should develop measures based on surgery types and patients' positioning types, so as to reduce the incidence of pressure injuries in the operating room.

並列關鍵字

Perioperative ； Surgical spinal patient ； Pressure injury

主題瀏覽