提升護理人員執行腦中風吞嚥功能評估能力之改善方案

A Project of Improving Swallow Assessments for Patients with Stroke

吞嚥困難是腦中風患者常見的障礙之一，未經吞嚥評估及訓練，病患容易因嗆食導致吸入性肺炎、營養失調等合併症及增加死亡率。現況分析發現護理人員對中風病患吞嚥功能評估之正確率僅有43.5%，認知正確率則為57.1%，故成立專案小組進行改善，並確立主要問題為吞嚥功能評估知識與技巧不足、沒有制定評估查核制度、缺乏工作規範、與缺乏評估指導書。透過在職教育訓練、設置吞嚥功能評估工作規範及查核機制、修訂評估流程、製作評估指導手冊與示範光碟等改善策略後，護理人員執行吞嚥功能評估之正確率提昇至90.3%，認知率提昇至92.9%，達本專案之目的，進而提昇病人安全與照護品質。

Dysphagia is a common complication that patients suffer from after a stroke. Without a proper assessment of swallowing ability and function evaluation (SAFE), the patients with stroke have a high risk of getting complications such as aspiration pneumonia and malnutrition, resulting in a higher rate of mortality. Prior to the start of an improvement project, only 43.5% of the nurses could accurately complement SAFE for patients with stroke, and 57.1% of them were aware of SAFE. This improvement project was based on resolving the identified problems: nurses' lack of knowledge and skills in SAFE, lack of a monitoring system, and lack of a SAFE policy and procedure. The projects included nurses' education training, establishment of a SAFE policy and procedure as a standard of practice, and a monitoring system. The education training focused on revising the SAFE workflow and making assessment guidance booklets and demonstration CDs. With these improvement measures, up to 90.3% of the nurses were able to implement accurate SAFE, and 92.9% of them were able to give correct answers to the questions. The goal of safe and high-quality patient care was achieved.