降低氣管內管留置照護措施不完整率

Reduction of Occurrence of Incomprehensive Care for Patients with Intubation

氣管內管留置照護措施不完整而導致管路滑脫，對病人不僅是二度傷害，甚至可能導致死亡。本單位依氣管內管留置病人照護認知表及措施查核結果，照護認知為71.5分、不完整率為33.7%，進而確立問題包括未定期舉辦在職教育、缺乏適用的約束帶及溝通圖卡、缺乏完整的入院衛教、缺乏完整的約束規範與稽核制度不完整。提出解決方案包括舉辦在職教育、研發及改良約束用物、修訂稽核制度與溝通圖卡、修訂約束規範及入院衛教內容、正確約束方式、管路固定及擺放位置、適當使用止痛劑及鎮靜劑等對策後，照護認知提升至100分、不完整率降低至0%、非計劃性氣管內管滑脫率自3.2%降低至0.5%。顯示專案措施成效良好，期望未來能將此創新方案推展至其他單位，以提升病人安全的照護品質。

Incomprehensive care of intubated patients can cause secondary injury or even death. Based on the cognition evaluation form regarding care of intubated patients and the audit of the implementation, the caring cognition showed a score of 71.5 and the rate of incomprehensive care was 33.7%. The following problems were therefore established: (1) no regular in-service education, (2) devoid of proper restraint devices and communication picture cards, (3) lack of complete patient education on admission and integral restraint regulations and (4) the incomplete audit system. Solutions for these problems included (1) regular in-service education, (2) development and improvement of restraint devices, (3) revision of the audit system and communication picture cards, (4) amendment of restraint regulations and content of patient education, (5) correct restraint, (6) correct fixation and placement of endotracheal tubes (7) appropriate usage of analgesics and sedatives. After execution, the score of caring cognition increased to 100 and the rate of incomprehensive care reduced to 0%. Besides, unplanned extubation rate decreased from 3.2% to 0.5%. The whole project showed good achievement and deserved spreading to other medical units in order to improve patient safety.