呼吸照護病房病人皮膚濕疹改善方案

A Project to Improve Therapeutic Efficacy for Skin Eczema in Respiratory Care Ward Patients

本專案目的為提高呼吸照護病房病人皮膚濕疹改善率並以定義治療一週後濕疹面積減少30%以上為有效改善。專案實施前進行調查，改善率僅30%，故引發執行此專案動機。分析發現照服員執行病人身體清潔不正確、護理人員未確實紀錄評值皮膚狀況以及照護人員藥膏塗抹不正確等為皮膚濕疹未改善之主因。針對導因予研擬照服員床上沐浴技術標準並進行技術稽核、設立皮膚評值表作為評值及給藥依據、設置外用藥膏給藥標準流程及稽核表、藥膏衛教圖卡等措施。結果顯示濕疹改善率提升至70％且降低藥材成本。皮膚照護為呼吸照護病房之重要醫療照護，本專案以跨團隊系統性之照護措施並增加醫護人員及照服員對濕疹照護的知能有效提升濕疹改善率。

This project aims to improved the therapeutic efficacy for skin eczema in respiratory care ward(RCW). The definition of effective in the context of this project is the reduction of eczema surface area equal or higher than 30%. The baseline survey found the effective treatment rate was 30% only, which facilitated the project. We therefore conducted a transdisciplinary assessment and identified three major causes of the ineffective treatments: Incorrect patient body cleaning, incomplete documentation of patient skin assessment by the nursing staff, and misuse of prescribed ointments by the nursing staff. In response, a multidisciplinary strategy was implemented, including standardization of bed bath skills with regular inspections, establishment of standard skin assessment chart as basis for evaluation and drug administration, and standardization of skin ointments application with checklist and illustration cards. After the implementation of the nursing interventions, the therapeutic efficacy improved drastically from 30% to 70%, and the medical cost successfully reduced. Skin care is essential in the medical services in RCW, and we have shown that our multidisciplinary nursing strategy could improve the therapeutic efficacy for skin eczema in the reported RCW patients and the cognition of nursing staff and assistant nurses in eczema care.