運用皮膚照護群組模式降低肺癌住院病人壓瘡發生密度之成效

The Effectiveness of Care Bundles in Maintaining the Skin Integrity and Reducing the Incidence Density of Pressure Ulcers in Lung Cancer Inpatients

背景：壓瘡是皮膚受到任何漸進性傷害後形成的組織缺損，屬於皮膚完整性照護的問題，也是重要的臨床品質指標。自2010年1月至2011年3月肺癌住院病人的壓瘡發生密度平均值約2.09%，明顯高出其他住院病人約8倍之多，分析原因為缺乏照護標準、病人特性、以及護理員人評估不完整等。目的：本專案目的為運用皮膚照護群組模式降低肺癌住院病人壓瘡發生密度。解決方案：實施壓瘡預防群組實證措施、增加壓瘡高危險群照護對象及教導使用「壓瘡預防策略照護群組表」紀錄，進行日常照護活動。結果：從2011年11月到2012年1月的專案執行期間，肺癌住院病人壓瘡發生密度降至0.55%，之後8個月的效果追蹤亦可維持每月在0.33%。結論：藉由「照護群組」概念，建立實證照護標準作業，持續強化臨床護理人員照護能力及經驗，進行壓瘡品質監控，嘉惠更多病人。

Background & Problems: Pressure ulcers are tissue defects that form on the skin as a result of progressive skin damage. Pressure ulcers are a skin-integrity-related care issue and an important clinical indicator of care quality, especially for lung cancer inpatients who face rapidly deteriorating health conditions due to multiple symptoms and the side effects of treatment. Treating severe pressure ulcers may consume considerable manpower, time, and medical resources. Pressure ulcers may be avoided or effectively treated when nurses conduct proper skin assessments and care for wounds properly.Purpose: This project evaluates the efficacy of skin care bundles in terms of reducing the incidence density of pressure ulcers in lung cancer inpatients.Resolution: Data gathered between January 2010 and March 2011 showed unstable incidence density for pressure ulcers. The average pressure-ulcer incidence density in lung cancer inpatients was 2.09%, which was 8-times higher than the average for all patients. Using evidence-based care bundles for pressure ulcer prevention, we trained nurse staffs to incorporate these bundles into their clinical daily care of lung cancer patients in our hospital.Results: During the study period between November 2011 and January 2012, the pressure-ulcer incidence density gradually fell to 0.55%. The incidence density continued to fall to 0.33% over the subsequent 8 months.Conclusions: We used the concept of ”care bundles” to establish a standard skin-care protocol for advanced lung cancer inpatients. This protocol improved the clinical ability of nursing staffs and effectively maintained skin care quality in lung cancer patients.