提升病患成功脫離呼吸器之專案改善

The Effect of Ventilator Weaning Program at the Respiratory Care Center

運用胸腔復健運動以提升病患成功的脫離呼吸器，不僅可減少病患住院天數，增加病患自主能力，並可維持良好居家生活品質。本院呼吸照護中心(RCC)2005年4月至2006年3月呼吸器脫離率僅48％，平均住院天數為41天，現況調查後發現主要原因為執行胸腔復健率偏低，僅29％，造成此執行率偏低原因有：護理人員認知度僅78％、缺乏胸腔復健執行標準，以及家屬輪換率高達77％，且家屬有58％使用非中文語言，同時缺乏合適衛教工具等。本專案的目的是藉由提升胸腔復健執行率以增加病患呼吸器脫離率。經本專案小組於2005年12月至2006年6月共同擬定及推動解決方案：一、修訂呼吸器脫離路徑、胸腔復健執行標準作業流程及護理指導內容；二、製作衛教指導工具；三、舉辦教育胸腔復健訓練課程。經過本專案改善後，於2006年6～8月評值護理人員的認知度由78％提升至100％、胸腔復健執行率由29％提升至88％、呼吸器脫離率由48％提升至62％、平均住院天數由41天降至24天，換算其成本共減少57,290元／月。呼吸照護中心是未來脫離呼吸器病患的主要轉接單位，經由本專案能提早加強病患復健運動，使病患儘早脫離呼吸器，並能減少住院天數及其支出，以提升病患之生活品質。

Pulmonary rehabilitation could improve the likelihood of weaning of those ventilator-dependent patients. Not only does it shorten the duration of hospital stay, it also allows a better quality of life. The weaning rate at the Respiratory Care Center (RCC) of one teaching hospital in northern Taiwan was 48% (April 2005-March 2006) and the average length of stay (LOS) in hospital was 41 days. An observed poor execution of pulmonary rehabilitation, which was only carried out 29% of times, could be due to the lack of understanding by the nursing staff, lack of on-job training, absence of concrete procedure standards, policy, and supervision. An average score of 78% from nursing staff was obtained with regard to the overall understanding of pulmonary rehabilitation. Moreover, the rate of family member taking turns reached as high as 77%. About 58% of the family members were not native Chinese speakers. In addition, there were no appropriate tools for conducting health education. The purpose of this project was to increase the weaning rate at the RCC by increasing the execution of pulmonary rehabilitation. The strategies included revising procedure standards, developing an appropriate tool, and setting up on-job training programs Two months after the program, nurses’ understanding of pulmonary rehabilitation improved to 100% and the execution rate increased to 88%. The ventilator weaning rate increased from 48% to 62%, LOS decreased to 24 days, translating to an average saving of NT$ 57,290 per month in hospitalized. The RCC is the transfer unit to improve the outcome of ventilator-dependent patients. Optimized strategies targeting education of nursing staff on aspects of pulmonary rehabilitation may improve the outcome of ventilator-dependent patients, such that improved the possibility of weaning, shortened duration of hospital stay, less hospitalization expenses, and better quality of life could be obtained.