運用品管圈的方法降低加護病房管灌營養品退回率

加護病房（intensive care unit, ICU）管灌食的病人，會因疾病變化、檢查、治療等因素，造成無法灌完營養配方，而退回營養室。為避免交叉污染，退回的管灌營養品均會丟棄，造成食材浪費。因此營養室運用品管圈手法，希望建置管灌食管理機制，來降低ICU管灌營養品退回率。於2019年4至5月蒐集ICU管灌營養品退回數量、種類及退回原因，經要因解析後，提出介入對策。一、主動出擊策略（主動調整飲食處方），包括：一、當床邊累積兩餐管灌營養品，予以停一餐或減量，二、於查房時，與醫師確認飲食醫囑，三、每日確認訂餐系統符合飲食醫囑，四、對ICU醫療團隊進行「管灌醫囑與灌食速度對照表」，及「追加灌食速度（catch-up feeding）原則」之教育訓練，以提升每日灌食目標。二、點名策略（檢查灌食路徑之正確性）：對管灌食病人，確認灌食管路之適當性。三、唸經策略（加強管灌營養品隨床帶出宣導）：護理長加強宣導，轉出ICU，確認管灌營養品一併帶出。本圈設定ICU管灌營養品退回率（退回管灌營養品／供應管灌營養品數量）目標為0.75%，對策實施後，退回率由1.48%下降至0.74%，減少3972元浪費。目標達成率達101%（〔改善後－改善前，〕／〔目標值－改善前〕×100%）。本研究顯示運用品管圈手法成效良好，且能落實及持續執行。

關鍵字

品管圈；加護病房；管灌營養品；退回率

並列摘要

For patients in the intensive care unit (ICU), tube feeding is often incomplete because of changes in disease, tests, and treatment, and the remaining enteral nutrition is returned to the Nutrition Department. To avoid cross-contamination, returned enteral nutrition is discarded, resulting in a waste of ingredients. Therefore, the Nutrition Department has adopted quality control circles in order to establish a management mechanism for tube feeding foods to reduce the return rate of enteral nutrition in the ICU. In April and May 2019, we collected the number, type, and reasons for the returned enteral nutrition in the ICU and proposed intervention strategies after analyzing key factors. Strategy I. The proactive strategies (proactive adjustment of dietary prescriptions) include (1) suspending one meal or reducing the amount of enteral nutrition when the patient has accumulated 2 unfeeding meals at the bedside; (2) confirming the diet prescription with physicians during room visits; (3) confirming daily that the meal ordered by the meal ordering system is in accordance with the diet prescription; (4) providing education and training to the ICU health care team on ＂Tube Feeding Orders and Feeding Rate Comparison Chart＂ and ＂Catch-up Feeding Principles＂ to improve daily feeding goals. Strategy II. The roll call strategy (check for correct feeding route): confirm that the feeding route is appropriate for the tube feeding patient. Strategy III. The chanting strategy (strongly advocating taking the enteral nutrition with the bed): the nurse supervisor strongly advocates that the nurse should confirm that the enteral nutrition has been taken with the bed when the patient is transferred out of the ICU. The target return rate of enteral nutrition (number of enteral nutrition returned/number of enteral nutrition supplied) for the ICU was set at 0.75%. The return rate decreased from 1.48% to 0.74% after strategy implementation, reducing waste by NT$ 3972. The target achievement rate was 101% ([after improvement - before improvement] / [target value - before improvement] × 100%). This study shows that the quality control circle technique is effective and can be implemented and sustained.

並列關鍵字

enteral nutrition ； intensive care unit ； quality control circle

國際替代計量

運用品管圈的方法降低加護病房管灌營養品退回率

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