外科加護病房護理人員抬高床頭正確率降低吸入性肺炎比率改善方案

Enhancing SICU Nurses' Correct Implementation of the Head-of-Bed Elevation to Decrease Pneumonia Rate Project

丁靜宜(Ching-I Ting) ； 顏慧芳(Hui Fang Yen) ； 邱如玉(Ju-Yu Chiu) ； 林琪馨(Chi-Hsin Lin)

《台灣健康照顧研究學刊》 16期 (2014/03) Pp. 31-53

摘要

抬高病人床頭高度至30-45度是預防吸入性肺炎與降低腦壓的重要護理處置。在一外科加護病房，筆者觀察到護理人員臨床執行此措施的正確率只有13%，2012年1-7月的肺炎感染密度（千分之2.78）居院內加護病房之冠，歸咎主要原因為（1）護理人員不知抬高床頭措施的重要性，（2）沒被告知如何判斷正確床頭抬高高度。目的：改善床頭抬高的正確率與降低吸入性肺炎感染比率。方法：實施介入措施包含：（1）運用角度測量儀，訂出床頭抬高30與45度的正確高度，（2）將抬高床頭措施列入護理人員每日照顧與交班注意事項規範，（3）舉辦兩堂在職教育並配合圖像說明，（4）運用個人電子信箱傳達訊息給每一個人，（5）將抬高床頭措施列入小組長每日查核內容來落實人員執行率。結果：正確床頭抬高率從13%改善至60%；肺炎感染密度有效的連續三個月維持低於千分之1以下。結論:提昇護理人員床頭抬高的正確率措施確實能降低單位肺炎感染比率。

關鍵字

床頭抬高 ； 吸入性肺炎 ； 肺炎感染比率

並列摘要

Background and problem: Elevation the patient's head-of-bed to 30-45 degree is one most important nursing intervention for preventing aspiration pneumonia and decreasing intracranial pressure. In a surgical critical care unit, the authors observed that the rate of nurses' correct elevating head-of-bed to 30-45 degree is only 13%. From January to July, the average pneumonia density (2.78 per mile) had become the highest rank among all ICUs in 2012. The main causes of this problem were the importance of head-of-bed elevation was not aware by the nurse, and how to determine the correct height of head-of-bed was not told. Purpose: Improve correct implementation rate of head-of-bed elevation and decrease the pneumonia rate. Methods: There were five intervened strategies were used, including applying an angle measuring instrument to work out the correct height of head-of-bed in the degree thirty and forty five, mandatory writing the head-of-bed elevation into daily nursing care and hand-over precautions norms, setting up two in-service work shops with the image description, conveying this information through personal e-mail to everyone, and daily tracking the implementation of head -of-bed elevation done by leaders to force the nurse's execution rate. Result: The complying rate of head-of bed elevation was improved from 13% to 60%. The pneumonia density was successful maintained below 1 per mile for three consecutive months. Conclusion: Enhance the nurse's correct head up intervention can indeed reduce the unit's pneumonia rate.

並列關鍵字

Head-of-Bed Elevation ； Aspiration Pneumonia ； Pneumonia Rate