降低新生兒加護病房非計畫性氣管內管滑脫率

氣管內管對病人氣道的維護是很重要的，且非計劃性氣管內管滑脫率是醫療品質重要指標，一旦發生非計畫性滑脫，不僅對醫院成本造成耗費，也會危害病人安全。單位為新生兒加護病房，2016年氣管內管滑脫率高達1.15％，分析原因為無合宜之約束輔具、固定膠布滲濕未及時更換及未落實氣管內管照護安全。於2017年4月至2018年2月使用新生兒保護性約束輔具、改變氣管內管固定方式、訂定氣管內管照護評核表、製作教學影片及舉辦教育訓練等方案實施，非計畫性氣管內管滑脫率降至0％，達目標值。且護理人員於氣管內管照護安全執行率由46.4％提升至87.8％，有效提升了新生兒加護病房氣管內管照護品質，達年度病人安全工作目標。

關鍵字

新生兒加護病房；非計畫性氣管內管滑脫

並列摘要

The endotracheal tube is very important to the maintenance of the patient's airways, and the unplanned extubation (UE) rate is an important indicator to the medical quality. Once the unplanned removal occurs, apart from financial costing to the hospital, it will also endanger patient's safety. In 2016, the rate of UE in our neonatal intensive care unit was as high as 1.15%. After assessing the issue, we concluded problems include lack of suitable restraint aids, fixed adhesive tapes were not replaced in a timely manner, and lack of endotracheal tube care in-service education and securing techniques. After establish the methods aiming to reduce the risk of UE rate, those include apply the neonatal protective restraint aids, changes in the endotracheal tube adhesive tape fixation, design a protocol and checklist for securing endotracheal tubes care, produce teaching videos, organize educational training and so on. After implementing those measures, the rate of unplanned removal drop dramatically from 1.15% to 0%. In addition, the safety execution rate of nursing staff in endotracheal tube care increased from 46.4% to 87.8%. Our strategy has effectively improved the quality of endotracheal care in the neonatal intensive care unit, reduced the rate of UE, and reached the annual safety working goal for patients.

並列關鍵字

neonatal intensive care unit ； unplanned extubation

參考文獻

許重梅、張炎德、魏美觀、李寶琳、林英芬、林惠釧（2013）．計劃性拔管與非計劃性拔管病人之預後．呼吸治療，12(2)，17－27。https://doi.org/10.6269/JRT. 2013.12.2.02

溫淑如、范圭玲、吳美華、陳玉蓮、錢佳慧（2018）．降低兒童醫院加護病房非計劃性氣管內管滑脫率．台灣醫學， 22(3) ， 297 －310。https://doi.org/10.6320/FJM.201805_22(3).0009

鄭秋鳳、許雅雲、蘇綉雅、陳麗琴、林淑雯（2015）．降低新生兒加護病房非計劃性氣管內管拔除率．長庚護理， 26(2) ， 167 －178。https://doi.org/10.3966/102673012015062602005

梁牡丹、范圭玲（2015）．降低兒科加護病房非計畫性氣管內管滑脫率之改善專案．護理雜誌，62（3 附冊），39－48。https://doi.org/10.6224/JN.62.3S.39

Grant, M. J., Balas, M. C., Curley, M. A., & RESTORE Investigative Team (2013). Defining sedation related adverse events in the pediatric intensive care unit. Heart & Lung: The Journal of Critical Care, 42(3), 171-176. https://doi. org/10.1016/j.hrtlng.2013.02.004

國際替代計量

降低新生兒加護病房非計畫性氣管內管滑脫率

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