提升某加護中心壓瘡癒合率之專案

ICU Project to Improve Pressure Ulcer Healing Rates

壓瘡是65歲以上老年及慢性病長期臥床患者常見的問題，傷口若沒有完善的照護，除了延遲的癒合外，可能伴隨傷口感染、甚至死亡之合併症。本單位統計從2003年1月至6月期間壓瘡癒合率為0%。經分析後問題確立為：(1)護理人員壓瘡照護知識錯誤、(2)單位缺乏各級壓瘡明確的標準換藥流程、(3)減壓器材不適用、(4)處理排泄後皮膚護理不當等。目前臨床對壓瘡傷口的處理已採新的觀念與方法，但同仁的知識與行為並未隨之更新。故於7月成立專案小組期望能提升單位之壓瘡護理成效。經搜集文獻後，安排在職教育，宣導正確的壓瘡照護新知、製定壓瘡護理標準流程、設計軟水墊以改善減壓輔助設備、製作排泄後皮膚照護標準。經六個月後，壓瘡癒合率由0%上升至41.2%。本專案解決問題的策略不僅減少了病患身體的痛苦，也改善了護理品質，值得在臨床上繼續推展。

Pressure ulcers represent a very common complication in elderly and patients receiving bedridden care. Inappropriate management of this condition can lead to delayed healing, serious infections and even mortality. The rate of healing for pressure ulcers in our department was 0% between January and June, 2003. We studied this situation and identified the following problems: (1) improper diagnoses; (2) failure to implement a pressure ulcer care protocol; (3) lack of proper instruments to reduce pressure; and (4) failure to care properly for skin following excretion. Nursing knowledge and practice were not updated with new concepts and methods related to clinical pressure ulcer care. To solve these problems and improve pressure ulcer care effectiveness, we organized a special unit in July of the same year, which proceeded to arrange lectures and promotional campaigns, published a standardized care protocol, designed water cushions, and established proper post-excretion care procedures. According to observed results, our department improved its pressure ulcer healing rate by 41.2% within 6 months. This project improved skin care quality and reduced pressure ulcer complications. We recommend that findings and measures be promoted in clinical practice.