個案管理資料庫發展與應用

Promoting the Use of the Nasopharyngeal Airway to Treat Watery Diarrhea

本專案旨在改善「鼻腔通氣管引流水瀉置放術」未被護理人員廣泛應用，而導致本院一般內科加護病房之水瀉患者的肛門會陰部皮膚破損發生率為60.71%。現況分析後發現其因素有：(1)「鼻腔通氣管引流水瀉置放術」護理標準內容不易理解；(2)該技術未取得醫師的支持；(3)缺乏該技術的教育課程。經由文獻查證並與小組討論後，擬定下列措施進行改善，(1)修訂鼻腔通氣管引流水瀉置放術的技術標準，以圖片逐一說明管路的裝置程序；(2)於加護醫學部會議報告，取得醫師對該技術的支持；(3)進行「鼻腔通氣管引流水瀉置放術」教學方案與推廣計劃；(4)使用該技術的患者收案管理並提供護理照會。經由以上執行措施後，鼻腔通氣管引流水瀉置放術的使用率由60%提升為100%；且患者的肛門會陰部皮膚破損發生率由60.71%下降為0%。由此發現推行鼻腔通氣管應用於引流水瀉，可以改善皮膚的問題，因此期望藉由本專案提供給相關照護單位參考，以提升患者的照護品質。

Using the nasopharyngeal airway to promote stool drainage is currently limited in general clinical practice. This situation has led to periannal skin care administered by nursing staff not meeting patient expectations for treatment efficacy and speed of recovery. According to previous statistics, the incidence of perianal excoriation was 60.71% in critically ill patients with liquid stool. This project was designed to promote more widespread use of the nasopharyngeal airway to contain watery diarrhea and improve skin lesions. Reasons for not using the nasopharyngeal airway to promote stool drainage identified by the authors included: 1. unclear nursing standards with regard to such procedures; 2. physician resistance to the use of such and 3. lack of education programs related to such procedures. Improvement strategies included: 1. modifying nursing standards with detailed explanations and pictures; 2. earning physician acceptance of such procedures through case conference meetings in ICUs; 3. rescheduling education programs on the implementation of nasopharyngeal airway and skin care for patients with watery diarrhea and 4. establishing case management and nursing consultation systems. Results showed that use of the nasopharyngeal airway increased from an initial 60% to 100% at eight months following project implementation. The perianal excoriation rate fell from 60.71% to 0%. We found that drainage of liquid stool using the nasopharyngeal airway can reduce perianal skin complications. This project may be a valuable reference for other clinical practice to improve care quality.