降低加護病房壓瘡發生率之改善專案

A Project of Reducing Pressure Ulcer Incidence in Intensive Care Unit

徐琬茵(Wan-Yin Hsu) ； 李佳頵(Chia-Chun Li) ； 謝坤諺(Kun-Yan Xie) ； 陳幼梅(Yao-Mei Chen)

《高雄護理雜誌》 35卷1期 (2018/04) Pp. 29-41

https://doi.org/10.6692/KJN.201804_35(1).0003

摘要

重症病人因疾病複雜度高加上潛在壓瘡危險因子，因此，預防壓瘡是加護病房臨床照護重要議題。本院2015年壓瘡發生率為0.54%，高於同儕年平均值，故成立專案小組改善，專案進行期間：2016年3月至2016年11月。經臨床作業查檢分析確立問題為：翻身擺位照護不正確、管路照護不正確、缺乏預防壓瘡及管路照護準則、缺乏稽核制度、翻身輔具不足。經文獻查證與專案小組討論、發揮創意後擬定改善方案，包括：制定預防壓瘡及管路照護準則、舉辦教育課程、拍攝翻身擺位教學影片、設計海報及提醒板、增購輔具及管理及建立品質稽核制度等，期望將壓瘡發生率降至0.2%以下；經由實施改善方案後，壓瘡發生率由0.54%降至0.06%，達到專案目的也增進臨床照護品質。

關鍵字

降低 ； 壓瘡 ； 發生率 ； 加護病房

並列摘要

The patients in ICUs are at high risk of developing pressure ulcers for their critical condition, so pressure ulcer prevention is an important issue in the ICU. In 2015, the incidence of pressure ulcer in our hospital was 0.54%, which was higher than our peers' were, so we set up a project team for this problem, the project duration being from March 2016 to November 2016. After clinical data analysis, we assumed that the possible causes of pressure sore might be inadequate changing of patient position, inadequate tube care, lack of guidelines for pressure ulcer prevention and tube care, lack of audit system, and being short of position-changing assistive devices. So we performed a literature search, problem discussion, and we came up with some programs to improve bedsore incidence, including developing pressure ulcer prevention and tube care guidelines, developing an audit system, arranging training courses, making reminder posters and films, purchasing assistive devices, with the expectation that the incidence of pressure ulcers would be reduced to below 0.2%. After these programs, our pressure ulcer incidence declined from 0.54% to 0.06%. This project improved our clinical care quality and reached our goal.

並列關鍵字

reduction ； pressure ulcer ； incidence ； intensive care unit

參考文獻

于博芮、李世代、林壽惠(2005)．台灣醫療院所壓瘡風險評估工具之臨床效度．台灣老人醫學雜誌，1(2)，79-88。

吳祚光、鍾文珍、程麗玲、戴宏達(2009)．脊椎手術壓瘡預防與減壓擺位裝置之探討．榮總護理，26(2)，121-125。DOI：10.6142/VGHN.26.2.121

周繡玲、楊立華、馮容芬(2009)．建立傷口照護標準－以壓瘡傷口為例．亞東技術學院，29，243-256。

張素惠、張彩秀、陳妮婉(2012)．護理人員壓瘡預防行為之探討．弘光學報，69，136-153。DOI： 10.6615/HAR.201303.69.11

鍾卉庭、徐玲蕙、潘昭君、楊淑燕、陳婉宜(2011)．降低外科加護病房病人壓瘡發生率之專案．護理雜誌，58(3)，56-63。DOI： 10.6224/JN.58.3S.56