提昇居家護理個案鼻胃管移除率

Increase in Nasogastric Intubation Removal Rate in Home Care Cases

白淑芬(Shu-Fen Bai) ； 蔡美玲(Mei-Ling Tasi) ； 陳華玉(Hua-Yu Chen) ； 蔡美菊(Mei-Chu Tasi)

《長期照護雜誌》 17卷3期 (2013/12) Pp. 315-329

https://doi.org/10.6317/LTC.201312_17(3).0010

摘要

居家護理服務個案多為長期臥床，且日常生活需完全依賴他人照顧，因身體功能逐漸退化經常合併吞嚥障礙，而需長期留置鼻胃管路以維持營養所需，長期鼻胃管留置容易導致無法避免的合併症，更增加照顧者的照顧負荷及醫療成本，若能透過居家護理師早期適切的評估，執行吞嚥訓練，將有助於個案減少鼻胃管留置依賴及吞嚥失能所產生的合併症。筆者因發現單位管路移除率逐漸降低，基於促進個案恢復正常生理功能及監控照護品質的考量，透過邀請復健科醫師、語言治療師加入居家照護團隊共同討論，並規劃鼻胃管移除訓練相關在職教育課程、制定「居家護理個案鼻胃管移除標準作業」及監控計畫、設立「鼻胃管移除訓練執行紀錄表」，以落實評值家屬執行正確性及進度，確保管路移除訓練品質。專案實施後發現，鼻胃管成功移除率由12.4%上升至75.0%（上升62.6%），也讓個案享受進食樂趣，實為團隊合作最大貢獻，建議其他居家護理也能加強團隊合作，確保個案鼻胃管移除訓練的安全性，提供更適切的照護措施，提昇居家護理管路移除訓練的品質。

關鍵字

居家護理 ； 鼻胃管 ； 吞嚥訓練

並列摘要

Most of the home care cases are bedridden and fully dependent on others in activities of daily living. As the dysphagia occurs followed by degeneration of body functions, nasogastric intubation is used to meet the nutritional requirement for the patients. However, lengthy intubations often cause unavoidable complications that increase care burden and medical care cost. Complications of intubation can be reduced through early assessment and swallowing therapy performed by home care nurses.As decreases in intubation removal rate in home care cases were noted but to regain the function of the cases and to promote the quality of care, physiatrists and speech therapists were invited to join our team in planning swallowing therapy. Besides, standard protocol of intubation removal for home care cases and intubation removal training record were set up to assure the accuracy of the therapy.After implementation of the project, removal rate of nasogastric intubation increase from 12.4% to 75% (↑62.6%). Patients regain their function is a credit for the team's contribution. It's recommended for the other home care unit to be involved in multidisciplinary team and enhance teamwork to ensure the safety and the quality of nasogastric intubation removal.

並列關鍵字

home care ； nasogastric tube ； swallowing therapy