長期臥床病人因疾病導致意識、肢體功能障礙,需要照顧者協助執行口腔照護,但在執行口腔照護時,照顧者對口腔照護認知不足、病人抗拒及嗆咳等障礙,而無法確實執行完整的口腔清潔,易引發口腔疾病的急速惡化,導致整體健康更大的衝擊。本單位2016年3月發生4起口腔照護客訴事件,專案小組分析主要問題為:缺乏主要照顧者口腔照護指導標準、語言溝通困難、缺乏外語衛教輔具、護理人員缺乏在職教育。經建立主要照顧者指導標準、衛教相關工具(圖冊及影片、指導紀錄單、口腔照護稽核)、及創新雙效牙刷(牙刷結合抽吸功能)等措施後,口腔照護執行率由73.5%提升100%、口腔照護正確率由54.1%提升到95.5%、牙菌斑殘留率由79.5%降低至39.5%、口腔照護指導正確率由75.5%提升96.8%。由於專案推行讓主要照顧者能順利協助病人執行口腔照護,而雙效牙刷的創新廣泛應用在長期臥床病人,提升主要照顧者使用牙刷協助口腔照護的意願,減少長期臥床病人口腔問題及合併症的發生。
Oral care skills are important tasks in preventing comorbidities of long-term bedridden patients. There were four complaints related to oral care reported in March 2016. The project team discovered four major areas of deficit: (1) lack of oral care guidance and standards for primary caregivers, (2) difficulties in oral communications, (3) lack of foreign language education aids, and (4) lack of on-the-job education for nursing staff. Interventions included establishing the guidance standards for main caregivers, introducing educational tools (atlas and films, instructional records, oral care inspection), and using innovative double-cleaning-effect toothbrushes. The performance efficiency of oral care increases from 73.5% to 100%; the accuracy of oral care increases from 54.1% to 95.5%; the plaque residual rate decreases from 79.5% to 39.5%; and the accuracy of oral care guidance increases from 75.5% to 96.8%. This project demonstrated improvement in the performance accuracy of the main caregivers and the quality of patient care.