提升某加護病房護理人員執行口腔照護之正確率

Enhancing Nurse Implementation of Oral Healthcare in an Intensive Care Unit

背景：口腔照護師稽核各加護單位病人口腔狀況，發現本單位病人有口腔異味重、黏膜附著分泌物，及嘴唇乾燥未防護等問題。專案小組進行資料收集與實地觀察，分析後發現問題為：(1)護理人員認知不足、(2)缺乏針對急重症病人口腔照護標準、(3)缺乏口腔傷病照會流程、(4)缺乏口腔照護稽核制度、(5)照護輔具不良之問題。目的：本專案旨在提升加護病房護理人員口腔照護認知，及執行口腔照護正確率。解決方案：與口腔照護師討論，及文獻查證後，解決辦法為：(1)制定「加護病房口腔照護標準」及「病人口腔傷病照會流程」，提案護理部，納入標準技術、(2)增添照護輔具、(3)舉辦在職教育訓練、(4)定期稽核。結果：口腔照護認知得分80分以上由16%提升為90%；護理人員口腔照護正確率由19.69%提升為78.66%。結論：專案推行後，有效提升護理人員執行口腔照護之正確率，亦提升照護品質。

Background: Oral health professionals identified inadequate levels of patient oral health in our intensive care unit (ICU). A post-review analysis of collected data and field observation notes concluded that this problem resulted from several factors including: (1) Failure of ICU nurses to follow mouth care standards; (2) lack of oral injury care procedures; (3) lack of oral injury consultation procedures; (4) lack of oral care monitoring; (5) substandard oral care assistive devices.Purpose: The authors designed this project to raise general nursing staff knowledge of oral hygiene standards and increase the ability of nurses to implement proper oral healthcare.Resolution: After discussions with oral health professionals and reviewing articles in the literature, the authors implemented Critical Patient Oral Care Standards and Oral Injury Consultation Procedures and purchased new assistive care devices. The authors also conducted regular on-the-job training sessions for hospital staff that were reinforced by regular monitoring.Results: Training significantly increased nursing staff recognition of oral health care. Oral health care test scores rose from an initial average of 16% correct to a final average of 90% correct. Accurate implementation of oral health care in the ICU rose from an initial 19.69% to 78.66% of cases.Conclusion: This project significantly enhanced the accuracy and appropriateness of nurse oral health care delivery and quality health care promotion in the ICU.