提升某病房長期臥床病人壓瘡傷口癒合率之改善方案

Improving Healing of Pressure Ulcers in Bed-Ridden Medical Inpatients

李麗明(Li-Ming Li) ； 柯及婷(Chi-Ting Ke) ； 白菁滿(Jing-Man Bai) ； 李英芬(In-Fun Li)

《馬偕護理雜誌》 6卷1期 (2012/01) Pp. 24-35

https://doi.org/10.29415/JMKN.201201_6(1).0003

摘要

壓瘡是長期臥床者常見問題，被視為住院照護品質指標之一，壓瘡傷口的照護必須仰賴護理人員的評估及正確照護，才能促進傷口的癒合（楊，2009）。本病房發現臥床病人之二級壓瘡傷口癒合率偏低，本專案旨在提升內科病房壓瘡傷口癒合率。調查期間自2009年10月1日至10月25日，內容包括護理人員對照護技術之實際執行情形及壓瘡傷口認知，結果發現：護理人員對壓瘡照護技術及認知偏低。分析原因為：缺乏壓瘡傷口照護的教育訓練、使用壓瘡傷口的護理技術標準不合宜、缺乏追蹤傷口癒合及監測機制。經由規劃在職教育課程、修定壓瘡傷口護理技術標準、訂定壓瘡傷口監測辦法、製作壓瘡傷口敷料適應症手冊、制作壓瘡傷口測量工具及記錄表格。專案實施後，二級壓瘡傷口癒合率由0%提升至53.3%，另護理人員執行壓瘡照護技術正確率由44%提升到98%，對壓瘡護理認知之正確率由41%提升到98%。藉由本專案的推動，不僅增加護理人員的知能，更使壓瘡傷口獲得更好的照護品質。

關鍵字

長期臥床病人 ； 壓瘡傷口 ； 癒合率

並列摘要

Pressure ulcers are common problem for bed-ridden patients and are regarded as an indicator of the quality of care. Proper nursing assessment and management are required to promote healing of pressure ulcers. This study examined the incidence of pressure ulcers before and after implementation of a project to improve the healing rate of second degree pressure ulcers. Initially, we assessed the skills and knowledge of the nursing staff and found that they scored low on both aspects. The reasons for the poor scores included lack of adequate training in pressure ulcer care, an inadequate protocol for managing ulcers, and no clear procedure for monitoring ulcer healing. We developed an in-service education program, revised the pressure ulcer protocol, reestablished guidelines for monitoring healing, produced a manual on ulcer dressing, and defined an assessment tool for pressure ulcers. After implementation of the program, the healing rate of second degree pressure ulcers increased from 0% to 53.3%, nurses' skills improved from 44% to 98%, and staff awareness of pressure ulcers rose from 41% to 98% The project succeeded in raising the rate of ulcer healing as well as improving the nursing staff's understanding of the condition.

並列關鍵字

bed-ridden ； pressure ulcer ； healing rate