護理人員對慢性阻塞性肺疾病老年病患使用定量噴霧劑護理指導改善專案

Improving the Application of Metered-Dose Inhaler in Geriatric Patients with Chronic Obstructive Pulmonary Disease

本專案旨為護理人員對COPD老年病患使用定量噴霧劑(MDI)護理指導成效不彰進行改善。臨床常見老年病患提出MDI要如何使用，或因操作錯誤造成反覆入院，引發作此專案改善的動機。經調查原因為護理人員對MDI認知不足、護理指導未落實執行、缺乏指導工具及監控辦法，造成老年病患操作MDI正確率僅48.6％。擬定介入措施：護理人員的教育訓練及制定操作指引、監控表、衛教本、衛教光碟、衛教刊版，結果顯示護理人員對MDI認知由51.8％提昇至90.4％，護理指導執行率由52.6％提昇至100％、正確率由36.7％提昇至100％，老年病患使用MDI正確率由48.6％提昇至90％。本改善專案成效可推廣到其他老年常見慢性疾病之護理指導，來改善護理指導完整性以提昇護理品質。

This project was designed to improve the effectiveness of instructing geriatric patients with chronic obstructive pulmonary disease (COPD) using metered-dose inhaler (MDI). Misunderstanding of the directions of using MDI and/or incorrect operation of MDI device had made the geriatric patients being readmitted to the hospitals for acute lung problems. After analyzing the problems, we found that inadequate knowledge of the MDI device among nursing staffs, inaccurate instruction for the use of MDI offered by nurses, and lack of tools for instruction, and lack of monitoring system were the main factors that affected the proper use of MDI. Only 48.6% geriatric patients could properly use the MDI device. In order to solve the problems, we established guideline for the use of MDI, constructed a monitoring chart, edited educational handbook, video disk, and publications, and carried out on-job training program for the nursing staff. After the program, the recognition of MDI device by nurses increased from 51.8% to 90.4%, the performance of nursing instruction increased from 52.6% to 100%, and the correctness of nursing instruction also increased from 36.7% to 100%. Ninety per cent of the geriatric patients can properly use the MDI in contrast to 48.6% before the intervention. This project has established an intervention model for caring geriatric patients with other common chronic diseases so that the completeness of nursing instruction as well as the quality of nursing care can be improved.