運用皮膚照護群組預防非侵襲性正壓呼吸器之臉部壓傷

SSKIN Care Bundle as a Standard Procedure to Prevent Facial Pressure Injuries in Patients with Noninvasive Positive Pressure Ventilators

非侵襲性正壓呼吸器（noninvasive positive pressure ventilation, NIPPV）為一種透過面罩或鼻罩提供正壓通氣的呼吸器，而臉部壓傷為其常見的合併症之一。經統計，本單位2016年01至09月NIPPV臉部壓傷發生率達84%，由現況分析發現：護理人員缺乏完整性照護NIPPV臉部皮膚的認知、單位未設有「預防NIPPV臉部壓傷照護指引」、缺乏評估NIPPV臉部皮膚之查核工具及缺乏相關監督機制為主要原因。因此，本專案小組訂定的解決方案包括:建立NIPPV臉部壓傷預防與照護指引、制定皮膚照護群組查檢表（SSKIN Care Bundle）、使用面罩型高密度泡棉敷料預防壓傷、以及定期稽核。在專案推行後，NIPPV臉部壓傷發生率降至0.4%，初步達成此專案之目的。希望藉由分享此專案，提供護理人員預防NIPPV臉部壓傷照護標準作業流程，進而提供病人更高品質的醫療照護。

Noninvasive positive pressure ventilation (NIPPV) is defined as a ventilation modality that supports breathing through a facial or nasal mask. Facial pressure injury is a common complication in patients with NIPPV. The incidence of facial pressure sore was 3.84% at our Medical Intensive Care Unit between January and September, 2016. The main reasons included the inadequate knowledge and skills of facial skin care among nurses, the lack of Guidelines of NIPPV-related facial injury prevention, the lack of assessment tool of NIPPV-related facial injury, and the lack of regular monitoring mechanism at our unit. The strategies proposed by the project included establishing the 'NIPPV Facial Injury Prevention and Care Guidelines', developing the 'SSKIN Care Bundle Checklist', the use of mask-type high-density dressing to prevent facial injury, and regular audits. After the implementation of this project, the incidence of facial pressure sore decreased from 3.84% to 0.4%. The result of the project could serve as a reference for promoting quality in nursing care of intensive care units.