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降低重症病房腹瀉病人失禁性皮膚炎發生率

Reducing the Incidence of Incontinence Associated Dermatitis in Intensive Care Unit Diarrhea Patients

摘要


背景:失禁性皮膚炎發生常見於重症病房腹瀉病人,病人需承受疼痛、發紅、腫脹等不適,處理不當甚至可能引發續發性感染,2013年10月至12月調查重症病房腹瀉病人失禁性皮膚炎平均發生率為34.72%,顯示此問題之嚴重性。經分析顯示四個主要原因為:(1)人員層面:護理人員照護方式不正確、未具備足夠失禁性皮膚炎預防及照護知識、清潔方式不正確;(2)設備層面:未提供隔離防護產品、尿布材質不透氣;(3)政策層面:缺乏失禁性皮膚炎照護標準、未定期稽核;(4)病人層面:皮膚水腫、失禁、使用藥物。目的:重症病房腹瀉病人失禁性皮膚炎發生率從34.72%下降至22%以下。解決方案:搜尋Cochrane、PubMed、CINAHI及Nursing Reference Center資料庫,年限2000年至2014年,搜尋到52篇文獻,刪除不相關文章,共4篇實證文獻,證據等級為level 2及level 3,依據文獻建議設計措施包括:設計高危險群標示、舉辦6場在職教育課程、錄影教學課程、製作失禁性皮膚炎預防及照護標準與流程圖及製定稽核制度。結果:2014年4月至10月失禁性皮膚炎平均發生率從34.72%下降至19.8%。結論:透過實證措施,確實達到預防重症病房腹瀉病人失禁性皮膚炎之成效,期望透過建立急重症病房腹瀉病人皮膚完善照護標準,期增進重症照護品質。

並列摘要


Background & Problems: Incontinence associated dermatitis (IAD) is a common skin disorder in critical patients who suffer from fecal incontinence. Symptoms of IAD include pain, redness, swelling, and, in some cases, secondary infections. IAD is thus a major problem faced in critical nursing care. The incidence of incontinence associated dermatitis averaged 34.72% at the intensive care unit in our hospital from October to December 2013. The factors that we identified as associated with IAD included: (1) Nurses: incorrect nursing care and insufficient IAD-related knowledge among nurses; (2) Devices: lack of skin barrier products and the use of diapers with poor air ventilation; (3) Regulations: lack of IAD care standards and lack of auditing oversight; (4) Patient problems: skin edema, incontinence, and medication use. Purpose: To decrease the incidence of IAD from 34.72% to 22%. Methods: The authors searched the Cochrane, PubMed, CINAHI, and Nursing Reference Center databases for relevant articles that were published from 2000 to 2014. Fifty studies were identified and four evidence-based references were selected for follow-up assessment. Levels of evidence were at levels 2 and 3. We designed an intervention that: (1) set a high-risk notice to increase awareness; (2) held six in-service training programs; (3) developed nursing standards and designed e-learning education lessons that specifically targeted reducing the incidence of IAD; (4) established a regular audit system. Result: The incidence of IAD decreased from 34.72% pretest to 19.8% posttest (posttest period: April-October 2014). Conclusion: This project effectively reduced the incidence of IAD in high-risk patients in our intensive care unit. The authors established evidence-based interventions that significantly improved patient outcomes.

參考文獻


徐筱茹、許美玉、章淑娟、鍾惠君、徐小惠(2013).重症病人失禁性皮膚炎盛行率及預測因子之調查.護理暨健康照護研究,9(3),210–217。[Shiu, S. R., Hsu, M. Y., Chang, S. C., Chung, H. C., & Hsu, H. H. (2013). Prevalence and predicting factors of incontinence-associated dermatitis among intensive care patients. Journal of Nursing and Healthcare Research, 9(3), 210–217.] doi:10.6225/JNHR.09.3.210
陳貞如、林子惠、施虹戎、周玫珍、王文玲(2008).提昇護理人員對成人失禁性皮膚炎之照顧能力.長庚護理,19(1),76–86。[Chen, J. R., Lin, T. H., Shih, H. J., Chou, M. J., & Wang, W. L. (2008). Increasing nurses’ competence in caring for adult patients with incontinence dermatitis. Chang Gung Nursing, 19(1), 76–86.]
莊寶玉、黃秀梨(2001).成人失禁性皮膚炎.護理雜誌,48(6),77–82。[Chuang, P. Y., & Hwang, S. L. (2001). Incontinence dermatitis in the adult population. The Journal of Nursing, 48(6), 77–82.] doi:10.6224/JN.48.6.77
Bale, S., Tebble, N., Jones, V., & Price, P. (2004). The benefits of implementing a new skin care protocol in nursing homes. Journal of Tissue Viability, 14(2), 44–50. doi:10.1016/S0965-206X(04)42001-4
Beeckman, D., Schoonhoven, L., Fletcher, J., Furtado, K., Heyman, H., Paquay, L., ... Defloor, T. (2010). Pressure ulcers and incontinence-associated dermatitis: Effectiveness of the pressure ulcer classification education tool on classification by nurses. Quality and Safety in Health Care, 19(5), e3. doi:10.1136/qshc.2008.028415

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