提升神經外科重症病人營養評估完整率之改善專案

Project to Promote the Complete of Nutrition Assessment in Neurosurgical Intensive Care Unit

加護病房重症病人約有90%以上會有營養不良狀況，應及早提供適切的營養照護；本單位為神經外科加護病房，經調查發現護理人員對重症病人營養評估完整率僅逹62.4%，原因為：營養評估認知正確率僅達63.7%、測量身高基準不一、缺乏營養評估輔助工具、僅依醫囑給予灌食、高危險篩選表不符合專科特性及可控的禁食天數平均達5.8天。自2011年3月1日至8月31日，專案成員參考文獻擬定改善方案包括：（1）修訂神經外科重症病人營養不良評估暨處置標準；（2）營養不良高危險因子連結病人健康問題；（3）推動早食策略；（4）運用電腦系統計算熱量；（5）推展身高反推法；（6）舉辦專科營養評估教育訓練。最後營養評估完整率提升為97.7%及可控的禁食天數平均降為3天，足見方案有效改善問題，期望藉此提昇醫護團隊對營養評估的重視並提供適切的營養照護。

About 90% of the patients staying in the intensive unit have malnutrition problems. The project participants comprised of nursing staff from a neurosurgical intensive care unit. Based on our evaluation, the nutrition assessment accuracy at this unit was merely 62%. There were several issues related to the problem, insufficient knowledge about nutrition assessment among nursing staff (63.7%), inconsistency of height measurement, lack of nutrition assessment tool, insufficient individualized nutrition assessment, inappropriate high-risk screening list, and long fasting period for patients (5.8 days). The improvement project was from March 1, 2011 to August 31, 2011. After analyzing the current procedures, the proposed improvement project included: (1) revising nutrition assessment tool and malnutrition process procedures; (2) linking malnutrition risk factors to patient’s nursing problems; (3) carrying out the early-feeding intervention; (4) calculating calorie intake by the computer system; (5) applying height estimation method; and (6) arranging nutrition assessment training. After the improvement project, the completeness rate of nutrition assessment increased to 97.7%, and the average control fasting period decreased to 3 days. The project has improved the nutrition assessment and provided adequate nutrition care in the neurosurgical intensive care unit.