頭頸部癌症住院患者口腔護理成效之改善

A Project to Improve the Mouth Care toward Head and Neck Cancer Inpatient

葉淑妙(Shu-Miao Yen) ； 陳秀玲(Hsiu-Ling Chen) ； 黃秀美(Hsiu-Mei Huang) ； 黃雅燕(Ya-Yen Huang)

《嘉基護理》 10卷2期 (2010/12) Pp. 34-44

https://doi.org/10.29936/DMFCCHJN.201012.0004

摘要

本單位頭頸部癌症病患於化學治療或放射線治療期間發生口腔黏膜潰瘍比率高達90~100%，根據實證文獻，期能藉由改善口腔護理實施成效以降低頭頸癌住院患者口腔黏膜炎的發生率。專案於2008年9月1日～2009年2月10日實施。
專案小組經觀察現況、文件整理與查證文獻，分析造成本單位頭頸癌患口腔黏膜炎的原因：(1)頭頸癌症患者疾病與治療因素；(2)無口腔護理規範作為頭頸部癌症病患之照護標準；(3)未制定頭頸部癌症病患專用之口腔護理衛教單張；(4)護理人員對頭頸部癌症患者之口腔護理認知不足。本專案制定口腔護理規範、衛教標準和評估口腔黏膜指引，辦理護理人員口腔護理指導教育訓練等改善策略；專案實施成果顯示，頭頸癌病患的口腔黏膜炎發生率為90~100%下降為70%，發生時間平均延後2天；護理人員皆能正確評估病患口腔黏膜評估且口腔護理知識正確正確率由14.8分提升為20分（完全正確）。本專案各項改善措施具體降低頭頸癌患口腔黏膜炎發生率和提升護理人員評估病患口腔黏膜知識，可作為同儕臨床單參酌，據以提升頭頸癌患的照護品質。

關鍵字

頭頸癌症 ； 口腔黏膜炎 ； 口腔護理

並列摘要

Approximately 90-100% head and neck cancer inpatients experienced oral mucositis undergoing chemotherapy or radiotherapy in our ward. This project aim was reducing the incidence rate of oral mucositis by improving the mouth care according to evidenced literature. The project was conducted from September 1, 2008 to February 10, 2009. The project team identified the causes of high oral mucositis rate through onsite observation, document review, and literature review; the four reasons included: (1) the illness and anti-cancer interventions; (2) lack of mouth care standard protocol; (3) lack of specially designated mouth care education material for head and neck cancer inpatients; (4) nursing staff had not adequate moth care knowledge and sporadic oral evaluation. Four strategies were proposed, including establish standard mouth care protocol and education sheet specialize for head and neck cancer inpatients, established an evidence consistent tool for assessment mucosa, and taking place mouth care education toward nursing staff. Results showed that the mucositis incidence rate reduced from 90-100% to 70%, and the episode day take an average delay two days while patients at hospital. In additional, nursing staff could assess patients' oral mucous membrane correctly while their knowledge score of mouth care rose from 14.8 to 20 (completely corrected). Implementations of this project not only significantly reduced the head and neck inpatients' oral mucositis incident rate, but also enhance nurses' knowledge regarding rating scales for assessment of patients experience oral mucositis. The project may a valuable reference for other clinical practice to improve head and neck inpatients' care.

並列關鍵字

head and neck cancer ； oral mucositis ； mouth care