燒傷病人疼痛護理改善專案

Project: Improvement for Burn Patients’ Pain Management

疼痛為燒燙傷病人主要主訴及護理上最常見的問題，因此如何降低燒傷病人疼痛，向來是燒燙傷的臨床照護重點，為減輕或避免病人不必要的疼痛感受，本專案小組成員於2008年9月以查檢表觀察單位護理人員8位，病人19位，結果顯示疼痛護理措施完整率為43.1％，病人主訴疼痛平均時間為73.1分；專案會議以人員、制度及設備探討出執行不善之原因，在人員方面為護理人員照護知能、臨床技巧不足及工作規劃不當；病人方面為知能不足；在制度方面為疼痛照護計劃不完善、工作職責劃分不當及欠缺教育訓練；在設備方面為輔助設備不足且欠完善。針對上述導因提出的改善方法為加強疼痛護理教育訓練、修訂疼痛指標計畫、建立疼痛護理標準、修訂護理人員三班工作職責及全面檢視設備之適當性。經改善後，疼痛護理措施完整率由43.1％提升至84.3％。病人主訴疼痛時間由73.1分降至43.3分鐘內，已達到本專案設立的目標；藉由此專案，期望提供相關單位病人疼痛照護之參考措施，改善病人的疼痛問題，建立具有品質、安全與關懷之護理服務。

Pain is the major complaint and most asked question in burn-center. Reducing burn patients’ pain has been the focus of clinical care of burns. To alleviate and avoid the uncomfortable pain of patients, the project team analyzed checklist records of 8 nursing staffs and 19 burn patients in September 2008. The completion rate of nursing procedure was 43.1% and the patients suffered wound pain for 73.1 minutes on average. The project team reviewed the problems from three aspects, including nursing staff, caring procedures, and caring facilities. The nursing staff problems included lack of clinical skills, insufficient knowledge of the pain management, and improper work arrangement. The problems related to caring procedure included lack of pain education programs for nurses, inadequate quality control index for the pain management, lack of nursing care guidelines and standards for pain, and improper workload assignment. The problems associated with the facility included poor auxiliary and inadequate equipments. The improvement action plans included providing training courses and promotional programs, establishing a quality control plan of pain management, establishing clinical standards of pain management, revising the work responsibilities of nursing staffs for each shift, and checking and monitoring the sufficiency of equipment for pain care. After the improvement, the completion rate increased from 43.1% to 84.3% and the wait-time was down from 73.1 minutes to 43.3 minutes. The goals had been reached.