降低某加護病房病患壓瘡發生率之改善方案

The Improvement Scheme for Reducing the Pressure Sore Incidence in an Intensive Care Unit

本專案旨在降低某加護病房病患壓瘡發生率，專案動機係因本病房病患壓瘡發生率逐月上升，2012年壓瘡發生率1.75%高於內科加護病房1.14%；2013年第二季3.38%高於第一季1.93%。專案改善過程中藉由定期舉辦在職教育、培訓壓瘡照護種子人員、制定壓瘡照護規範與壓瘡照護查核表、訂定壓瘡通報獎勵辦法、改變鼻胃管固定方式、輪換血氧監測器的位置、添購減壓輔具與設備。實施後發生率2014年1至4季分別為0.93%、1.09%、0.64%、0.67%（2014年壓瘡發生率為0.84%），皆低於設定的目標值1.96%（2013年總年度內科加護病房壓瘡率）。本專案實施之經驗與成果，對未來照護上將建議單位全面性規劃相關減壓輔具設備，如脂肪墊、減壓床；持續規劃壓瘡在職教育，加強護理師對壓瘡的分級認知、預防照護，以有效的預防壓瘡發生。

This project aimed to reduce the incidence of pressure sores (PS) in an intensive care unit (ICU), because of a progressively increased incidence of PS and a higher PS incidence of 3.38% in the second quarter compared with that of 1.93% in the first quarter. Members of the improvement team developed strategies, including regular on-job training, training the trainers for PS care, developing the guidelines for PS care, creating a PS care checklist, implementing a rewards system for reporting PS, modifying the positioning for nasogastric tubes, alternating the position of blood pressure monitoring, and the acquisition of decompression aids and related equipment. After the implementation, the incident rate of PS decreased to 0.93%, 1.09%, 0.64% and 0.67% in first quarter, second quarter, third quarter and fourth quarter of 2014, respectively, all of which were lower than the average rate of 1.96% of the medical ICU in 2013. Our experience showed that the ICU needs standard procedures to prevent PS more effectively, and should have comprehensively redesigned facilities and equipment for pressure relief, such as specialized cushions and beds. On-job training for PS is necessary to improve nurses' knowledge of PS classification, prevention, and care.