造口用具應用於腹膜炎術後併有開放性引流管傷口照護之成效

Improvement of the Ostomic Materials Applying on Postoperative Peritonitis with Open-drainage

近本專案目的為運用造口用具於腹膜炎術後併有置放開放性引流管之傷口照顧，以減少臨床上護理人員花費在開放性引流管傷口護理的時數及提升病患對於開放性引流管之傷口照顧的滿意度。現況中發現護理人員執行開放性引流管之傷口照顧平均所花費的時間為14.64分鐘，開放性引流管之傷口照顧敷料的使用平均每次約重達335.00克及每次換藥後敷料重量約為530.63克，病患對於護理人員執行開放性引流管照護的滿意度為4.15、舒適度為3.50，顯示開放性引流管之傷口換藥方式仍有待提升。因此，綜合以上結果，進行本專案之改善方案：建構一套開放性引流管傷口照顧指引，提供護理人員評估開放性引流管傷口情形之依據，運用造口用具於開放性引流管之傷口照顧。經過本專案改善後護理人員在執行開放性引流管之傷口照顧平均所花費的時間由14.64分縮短為8.00分，且達統計上顯著差異；敷料的使用平均每次重量由335.00克減少為201.43克，且達統計上顯著差異，每次換藥後敷料重量由530.63克減少為236.43克，且達統計上顯著差異；病患對於護理人員執行開放性引流管照護的滿意度由4.15分提升為4.59、舒適度由3.50分提升為4.60，且達統計上顯著差異。因此，透過此專案改善後，減少護理人員所花費在開放性引流管護理的時數及敷料使用及提升了病患的滿意度。

The purpose of the project was to apply ostomic materials on postoperative abdomen wound with open-drainage to improve the time of wound care and patients’ satisfaction toward care. . Before the improvement program, the average time of wound care was 14.64 minutes, the average weight of dressing was 335.00 grams, the average weight of dressing after wound care was 530.63 grams, and patients’ satisfaction and comfortable level was 4.15 and 3.50, indicating the wound care of opendrainage needed to be improved. After analyzing the current procedures, the proposed improvement approaches included: (1) setting up wound care guidelines of open-drainage to assist nurses in wound assessment; and (2) application of ostomic materials on wound care of open-drainage. After the improvement program, the average time of wound care has decreased to 8.00 minutes, the average weight of dressing has decreased to 201.43 grams, and the average weight of dressing after wound care has decreased to 236.43 grams. The satisfaction and comfortable levels have also improved to 4.59 and 4.60, respectively. The program has improved the quality of wound care.