降低氣管內管留置病人疼痛之改善專案

A Project to Decrease Pain in Intubated Patients

氣管內管留置病人無法說話溝通，除害怕、焦慮，更有喉嚨疼痛、難以呼吸等感受，運用實地觀察及訪談收集資料，發現氣管內管留置病人喉嚨疼痛佔86%，疼痛次數以口腔護理、抽痰、翻身照護最多，其中口腔護理比例最高(79%)，疼痛程度以抽痰最嚴重(6±0.9分)，導因於護理人員未主動評估及介入、未注意管路牽扯、缺乏口腔護理固定氣管內管的工具及口水抽吸棒、無氣管內管留置病人翻身教育訓練。運用疼痛評估便利貼、穴位按壓、氣管內管固定帶、在職教育後，疼痛比例由86%下降至46%，疼痛程度由6±0.9分下降至3.93±0.62分達專案目的。本專案推行後有效提升氣管內管留置病人喉嚨疼痛照護品質，可平行推展至重症單位。

The aim of this project is to assess and to improve quality of pain management in intubated patients, specifically to educate the nursing staff on the knowledge and skills of pain assessment and analgesic medications. Aside from ineffective communication that can be challenging, time consuming and frustrating, intubated patients also experience fear, anxiety, throat pain, and difficulty breathing. This project, started from March through August 2013, gathered information via on-site observation and inter views, and discovered that 86% of the intubated patients suffered from throat pain. In regards to prevalence of pain, oral care, sputum suction, and turning-over process were tanked at the top, with oral care scoring the highest 79%. As for pain severity, sputum suction was ranked first (with a score of 6±0.9). The major causes leading to inadequate pain management were subsequently identified: (1) Absence of pain assessment and interventions from the nursing staff; (2) failure to notice entangled cords, wires or tubes; (3) lack of endotracheal tube fixation devices and saliva ejectors; (4) absence of training in turning-over intubated patients. Interventions to address these issues were introduced, including pain assessment stick posts, acupressure, endotracheal tube fixation device, and in-service education. After the implementation of the project, the pain score decreased from 6±0.9 to 3.93±0.62. Measures undertaken in the project had effectively enhanced the quality of care for intubated patient with throat pain, and improved the knowledge and skills of pain assessment and analgesic medications among the nursing staff.