降低肝膽胃腸科病人之鼻胃管阻塞率

Project to Decrease the Nasogastric Tube Occlusion Rate in a Gastrointestinal Unit

背景：住院病人因疾病或治療因素無法由口進食時，經由鼻胃管提供腸道營養及給藥是十分普遍的護理措施；然而，鼻胃管阻塞是此類病人常面臨的管路異常問題。根據本單位2011年1月至9月統計，鼻胃管阻塞事件共發生7件（0.76%），且經評估後皆必須移除重新放置。目的：降低鼻胃管阻塞率低於0.31%。解決方案：實施的措施有：（1）舉辦護理師管灌技能在職教育訓練、（2）單位設置磨粉過篩裝置、（3）制定「Esomeprazole（Nexium®）藥物灌藥技術」、（4）鼻胃管管灌技術標準並修訂「鼻胃管灌食技巧」護理指導單張、以及（5）定期稽核護理師之鼻胃管管灌及特殊灌藥技術正確性。結果：經專案實施後，鼻胃管阻塞率由原本0.76%下降至0%，護理師的管灌技術正確率提升，尤其是特殊灌藥技術正確率由16.7%提升至100%成效顯著。結論：本專案結合護理師、醫師、藥師等跨專業團隊合作方式共同商討，制定標準作業規範，改變護理師過去的管灌技巧，最後順利達成降低鼻胃管阻塞率目標。

Background & Problems: When oral intake is inadequate or not recommended for patients with underlying diseases or specific treatments, it is common for these patients to receive nutrition enterally through a nasogastric tube. However, tube occlusion is a common complication of enteral feeding tubes. Data collected at our hospital from January to September 2011 identified 7 nasogastric tube occlusion events. All events were resolved by replacing the original tube with a new tube.Purpose: The purpose of this project was to reduce the nasogastric tube occlusion rate to 0.31% or less.Resolutions: Implemented interventions included: 1) developing and administering a course for nurses on nasogastric- tube feeding techniques; (2) providing a filter for powdered medications; (3) developing a standard procedure for administering Nexium through nasogastric tubes; (4) updating patient-education pamphlets for nasogastric tube feeding; and (5) enhancing the quality of nurse auditing on nasogastric tube feeding techniques and nasogastric-tube medication-administration techniques.Results: The average nasogastric tube occlusion rate decreased from 0.76% to 0% and the average nasogastric tube feeding technique compliance rate for nurses increased. The accuracy rate for specific medication administration techniques through nasogastric tubes increased dramatically from 16.7% to 100%.Conclusion: The project involved a multidisciplinary team of physicians, nurses, and pharmacists. This team developed a standard protocol for nasogastric tube feeding and specific medication administration recommendations for nasogastric tubes; revised nursing practice standards; and decreased the rate of nasogastric tube occlusion.