呼吸照護中心病人氣管內管自拔改善專案

An Improvement Project for Preventing Patient Self-Extubation in Respiratory Care Center

氣管內管自拔會造成病人氣道損傷、低血壓、高血壓、心律不整甚至死亡。本單位於2007年8月1日至2008年7月31日氣管內管留置1,870人次，發生自拔件數共16件，自拔率0.9％高於前一年度，基於病人安全考量下，引發作此專案改善的動機。現況分析後發現其原因包含：病人覺得不舒服、病人缺乏安全感、病人想出院回家、護理人員對病人缺乏警覺心、護理人員約束認知不同及護理人員約束技術不正確。藉由本專案擬定預防氣管內管自拔防護標準作業流程、氣管內管自拔高危險篩檢表、溝通板及溝通手冊進行改善。專案實施後，氣管內管自拔率降至0.08％，本改善專案成效可推行到全院加護病房，在臨床照護氣管內管留置病人有一致性照護標準，且提升病人照護品質。

Self-extubation (removing endotracheal tube by the patient himself unexpectedly) may result in airway injury, hypotension, hypertension, arrhythmia, and even death. There were 1870 patient-times of indwelling endotracheal tube in our respiratory care unit (RCC) between August 1, 2007 and July 31, 2008. Self-extubation occurred 16 times during this period (self-extubation rate: 0.9%). This project was conducted to improve patient safety. After our analysis, we found the cause of self-extubation included discomfort, lack of sense of safety, will to go home, lack of alertness of nursing staffs, inconsistent cognition about restraint of nursing staffs, and incorrect restraining skills of nursing staffs. Under this project, we developed standard operating procedures to prevent self-extubation and screening tables for defining high risk patients of self-extubation, and improved communicating boards and communicating handbooks. By applying this project, the self-extubation rate significantly decreased to 0.08%. We believed that this improving project may be applied in all intensive care units to provide a consistent standard for caring intubated patients and to improve the quality of care.