頭頸癌惡性傷口臭味改善之方案

The Project to Improve the Stink of the Malignant Wound in Head and Neck Cancer

惡性傷口是一種複雜且難以癒合的傷口，對癌症病患而言是個極大困擾的症狀。由於本單位的惡性傷口照護現況分析後發現，病人及護理人員對於惡性傷口臭味改善的滿意度平均只得到1.31 和1.38 分。傷口發出惡臭味的問題是病人最在意的，也是護理人員照護時最困擾的難題，因此改善傷口惡臭味情形是照護者的一大挑戰。同時本專案證實以目前護理部制定的傷口護理技術標準來照護惡性傷口有其限制與不足，更突顯修訂惡性傷口照護標準流程的必需性與重要性。進而調查影響改善惡性傷口惡臭滿意度低下的原因，發現真因依序為：1.未制定「惡性傷口照護標準」；2.缺乏惡性傷口相關在職教育課程；3.未進行惡性傷口護理技術執行的控管，據此經由文獻查證後，擬定下列專案措施進行改善：（一）制定惡性傷口照護標準規範；（二）實作的在職教育及床邊教學演練；（三）進行惡性傷口護理技術執行的控管。經由以上專案執行措施後 ，不僅使得臭味程度由改善前平均4 分，執行後平均分數大幅降低至1.05 分；專案執行滿2 星期後的臭味改善的滿意度調查表，從專案前1.31 分提昇至3.95 分；使用惡性傷口照護稽核表，護理人員在惡性傷口換藥技術正確率提昇至84.61%，達到80% 的標準，可見專案改善效果已顯現。期望本專案成果能發揮拋磚引玉的效果，有更多同仁相繼的努力與突破，使癌症病人均能相當滿意本單位的惡性傷口照護品質。

Malignant wounds are complicated and difficult to heal, causing several symptoms that torment the cancer patients. According to the analysis report of cared-for patients with malignant wounds in our unit, patients rated 1.31 mean points in the satisfaction of improving the odor from malignant wounds. Patients cared most about the bad odor from the malignant wounds. Therefore, improving the bad odor is a big challenge in wound care. Meanwhile, through this project, we also searched for factors influencing the satisfaction from malignant wound care that led to a low satisfaction rate in improving the bad odor. The following items were listed: 1. There is “standard procedure in malignant wound care”; 2. Lack of correlated education or courses in malignant wound care; 3. No monitoring or checking while administering the standard procedure in malignant wound care. In this project, through investigating and verifying the literature and references, we drafted the following measures to achieve our goal: (1) Make the malignant wound be treated by the new “standard procedure in malignant wound care”;(2) On-the-job education program; and bedside teaching program; (3) Undergo checking procedures in the nursing department for malignant wound care. Using the above-mentioned executive measures, the mean odor effect was 4 points before improvement, and then decreasing to 1.05 points. As to the subjective odor satisfaction from our project as measured by a designed questionnaire over a period of 2 weeks, a score of 1.31 increased to 3.95 after the project. Using the malignant wound care checking form, the accuracy rate of performing technical standard procedures in our nursing staff increased to 84.61% for malignant wound care, reaching our goal of 80%. Clearly, this project improves the satisfaction and achieves our goal. We are sincerely thankful for the offer of this project to the unit of wound care for improving the quality of life in those head and neck cancer patients with malignant wounds.