一般外科病患術後傷口換藥疼痛改善專案

Improving Pain Management for Postoperative Dressing Change

於臨床工作過程中常發現換藥會使傷口疼痛增加，並且造成皮膚粘著性創傷，許多文獻也指出換藥被病人認為是最痛苦的護理措施，本專案調查顯示病患因消毒液所造成的傷口疼痛分數為3.5分，因膠帶造成的傷口疼痛分數為4.0分，因此本專案目的為將消毒液造成之傷口疼痛分數降至3.3分，膠帶所致之傷口疼痛分數降至3.4以下。本專案為改善傷口疼痛實施的措施有：將傷口換藥改用生理食鹽水消毒、改用2吋透氣膠帶固定敷料、並且以正確黏貼與撕除膠帶的方式進行傷口護理。實施改變消毒液後疼痛分數從3.5分降至2.7分；改變膠帶後疼痛分數從4.0分降至3.4分且傷口周圍皮膚粘著性創傷從54.9%降至20.6%。經過本專案措施確實能夠降低病患的疼痛程度，並且增加護理人員對傷口照護的認知，達到提升傷口照護品質的目的。

In clinical surgical settings, postoperative dressing changes increase patients' incision pain and trauma due to the adhesive tapes and are considered the most painful nursing intervention. Prior to the implementation of the project, the pain scores that patients experienced due to the use of antiseptics for the dressing change and the application of adhesive tapes were 3.5 and 4.0, respectively. The goal of this project was to reduce the pain scores caused by antiseptics and adhesive tapes to below 3.3 and 3.4, respectively. The improvement measures that were taken included replacing antiseptics with normal saline solution and using two-inch micropore tapes instead of adhesive tapes. The pain score decreased from 3.5 to 2.7 because of the change in antiseptics and from 4.0 to 3.4 due to the change of dressing tapes. Furthermore, the incidence of skin tearing secondary to removal of adhesive tapes during dressing changes decreased from 54.9% to 20.6%. Changes in both antiseptic solution and adhesive tapes have positive effects on reducing patient pain levels, enhancing nurses' knowledge of incision care, and promoting quality incision care.