提升加護病房護理人員執行止痛鎮靜劑之正確率

Improving the Accuracy Rate of Analgesics and Sedatives Administration in an Intensive Care Unit

背景：本加護病房以呼吸衰竭使用呼吸器的病人為大宗，病人使用止痛鎮靜劑甚為普遍。停用止痛鎮靜劑後，常發生意識混亂或認知程度改變，每月皆有病人停用止痛鎮靜劑超過三天未如預期恢復意識， 甚至未依預期時間清醒而需施打解毒劑，或做電腦斷層鑑別是腦部損傷或是止痛鎮靜劑過量。目的：提升加護病房護理人員使用止痛鎮靜劑之正確率由30.4%提升至60.8%。解決方案 經現況分析問題後，擬定解決方案：修定止痛鎮靜劑使用流程、安排在職教育宣導、建立團隊每日討論鎮靜目標值之機制、落實稽核制度。結果 護理人員止痛鎮靜劑使用之正確率由30.4%提升至93%。結論 護理人員正確運用「止痛鎮靜劑查檢表」，醫護間才易達成疼痛與鎮靜評估的一致性，提供病人先止痛再鎮靜，落實正確調整止痛鎮靜劑，提升專業用藥的照護品質。

Background & Problems: Patients with respiratory failure needing mechanical ventilation are common in the intensive care unit. These patients often require sedative and analgesic agents to alleviate their discomfort and to avoid causing associated safety issues. However, prolonged post-awakening confusion and changes in perception after withdrawal from sedatives and analgesic agents are common in daily practice. Thus, the optimal use of sedative and analgesic agents remains an important issue in the intensive care unit. Purpose: To optimize sedation by raising the rate of accuracy for administering analgesic and sedative agents in the intensive care unit from 30.44% to 60.88%. Resolution: We first analyzed the problem from the current situation of the daily practice and revised the protocol of using analgesic and sedative agents. In order to achieve an optimal outcome, the authors further arranged staff education and bedside training and established an audit system to check and improve protocol adherence. Results: The rate of accuracy for administering sedatives and analgesics improved from 34% to 93%. Conclusions: With appropriately scaled protocols of sedatives and analgesics administration, intensive care nurses may easily target the consistent and optimal assessment and provide pain relief prior to sedation, which will improve the quality of sedation and patient safety.