降低置放氣管內管病人皮膚撕裂傷發生率

A Proposed Strategy for the Reduction of Skin Tears in Intubated Patients

戴如君(Ru-Chun Tai) ； 陳蕙茹(Hui-Ju Chen) ； 高玉玲(Yu-Ling Kao)

《源遠護理》 8卷3期 (2014/12) Pp. 49-56

https://doi.org/10.6530/YYN/2014.C.06

摘要

背景與問題：使用易拉膠布固定氣管內管病人常發生臉部皮膚撕裂傷，統計三個月皮膚撕裂傷發生率高達17.82%，經分析發現：（1）護理師撕除技巧不足，易拉膠布撕除技術正確率僅65.31%、（2）護理師執行預防性保護措施標準不一。目的：使用易拉膠布固定氣管內管病人皮膚撕裂傷發生率由17.82%降至8.91%。解決方案：（1）舉辦皮膚照護在職教育，建立照護共識、（2）修訂氣管內管護理流程、（3）透過稽核機制，即時解決執行問題，提升執行動機及成效。結果：2013年6月1日至8月31日氣管內管膠布固定之皮膚撕裂傷發生率由17.82%降至3.5%；易拉膠布撕除技術正確率由65.31%提升至98.1%。結論：透過教育課程、示範教學、修訂氣管內管護理流程、每週不定期的稽核，可降低氣管內管膠布固定之皮膚撕裂傷發生率。

關鍵字

皮膚撕裂傷 ； 發生率 ； 無痛保膚膜 ； 氣管內管 ； 品管控制

並列摘要

Many intubated patients experienced facial skin tears during removal of the elastic surgical tape used to secure the endotracheal tube. Data collected between December 1, 2012 and February 28, 2013, indicated that the rate of facial skin tears was 17.82%. The goal of this project was to reduce the incidence of skin tears in intubated patients by 50% or more. Observations of nursing techniques that lead to facial tears include: (1) Improper tape removal procedures. Observation of performance revealed that the correct execution of removal technique was 65.31%. (2) Lack of consistent preventive measures to protect patients' skin. Our improvement strategies include: (1) Specialized training on standards of skin care procedures. (2) Incorporate proper tape removal technique in endotracheal tube care. (3) Establish a quality control (QC) team to monitor nursing techniques on proper skin care. Results showed that the skin tears rate in intubated patients decreased from 17.82% to 3.5% and the rate of proper tape removal increased from 65.31% to 98.1%. In conclusion, the strategy on specialized staff training, revision of the endotracheal tube care procedures, and a QC team to conduct weekly monitoring of nursing techniques effectively reduced the incidence rate of skin tears in intubated patients.

並列關鍵字

skin tears ； incidence rate ； no sting barrier film ； endotracheal intubationm ； quality control