降低慢性精神科病患異物哽塞發生率

精神科病房的異物哽塞事件，通常搶救不易，致死率高，因此防範哽塞是精神病房照護中是不容忽視的議題，本精神科慢性病房在2017年間共發生4次嚴重異物塞事件，因此成立專案小組，自2017年8月1日～2018年8月31日，透過專案小組觀察、訪談，確立導致病患哽塞發生率高的原因有包括：不當的進食習慣，未落實評估、缺乏警覺性、用餐動線不良、無統一進餐流程、缺乏輔助用具等，經矩陣分析，實施教育訓練、規劃用餐區域、標準化進餐流程、修改作業規範、並和營養師合作，建立膳食異常通報機制，結果哽塞發生率可由0.02%降至0.00%，經專案的對策實施提供安全的進食環境及作業規範，有效的降低慢性精神病患的哽塞發生率，可做為未來照護的參考。

關鍵字

慢性精神科病患；異物哽塞；安全進食

並列摘要

Foreign body choking in psychiatric wards is usually difficult to rescue and causes a high fatality rate. Therefore, to prevent from choking is an issue that cannot be ignored in the care of psychiatric wards. Four serious foreign body congestion incidents occurred in 2017; consequently, a foreign body choking task force for psychiatric patients. From August 1, 2017 to August 31, 2018. Through observations and interviews by the task force, the reasons for the high incidence of patient choking have been established including: improper eating habits, failure to implement assessments, lack of alertness, poor meal flow, lack of uniform meal procedures, lack of auxiliary equipment, etc. After matrix analysis, implementation of education and training, planning of dining areas, standardized meal procedures, modification of work specifications, and cooperation with nutritionists, established a dietary abnormal notification mechanism, the result of choking incidence rate can be reduced from 0.02% to 0.00%, provided by the implementation of countermeasures for this project Safe eating environment and work practices can effectively reduce the incidence of choking in patients with chronic mental illness, which can be used as a reference for future care.

並列關鍵字

Chronic psychiatric ward ； Foreign body choking ； Safe eating

參考文獻

余文雯、黃宣宜、王愛玲、賴吟香、陳惠君 (2015)。運用醫療失效模式與效應分析降低精神科住院病人異物哽塞發生率。精神衛生護理雜誌，10(2)，26-34。http://doi.org/10.6847/TJPMHN.201512_10(2).0003

Chen, C. F., Chen, Y. F., Chan, C.H., Lan, T. H., & Loh, E. W. (2015). Common factors associated with choking in psychiatric patients. Journal of Nursing Research, 23(2), 94-100. http://doi.org/10.1097/JNR.0000000000000060

Allen, D. E., de Nesnera, A., & Robinson, D. A. (2012). Psychiatric patients are at increased risk of falling and choking. Journal of the American Psychiatric Nurses Association, 18(2), 91-95. https://doi.org/10.1177/1078390312440325

Appelbaum, K. L., Bazemore, P. H., Tonkonogy, J., Ananth, R., & Shull, S. (1992). Privilege and discharge decisions for psychiatric inpatients with dysphagia. Hospital &Community Psychiatry, 43(10), 1023-1025. http://doi.org/10.1176/ps.43.10.1023

Hwang, S. J., Tsai, S. J., Chen, I. J., Hsu, F. C., Li, C., & Kao, K. P. (2010). Choking incidents among psychiatric inpatients: A retrospective study in Chutung Veterans General Hospital. Journal of the Chinese Medical Association, 73(8), 419-424. https://doi.org/10.1016/S1726-4901(10)70090-3

國際替代計量

降低慢性精神科病患異物哽塞發生率

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