重症病人醫療黏膠相關皮膚損傷之改善成效

The Reduction of Medical Adhesives Related Skin Injuries in Critical Ill Patients

本研究目的在探討加護病房重症病人，發生醫療黏膠皮膚損傷後，相關介入措施之成效。本研究 收集2014 年1 月至2014 年3 月某醫學中心加護病房重症病人，因醫用黏膠產品造成皮膚損傷之發生率、 嚴重程度及護理人員使用醫療黏膠之照護正確率。並透過介入措施，包括訂定預防醫療黏膠相關皮膚損 傷之護理標準、建立使用醫療黏膠之操作標準，及皮膚保護措施、建立查檢及稽核制度、進行預防醫療 黏性產品導致皮膚損傷之在職教育。本研究12 個月期間，醫療黏性損傷人數及發生率由研究前期之189 人次/952 人日，19.9%，下降至介入措施後之21 人次/585 人日，3.6%；二級皮膚損傷發生比率由研究前 期117 人/189 人，61.9%，下降至介入措施後6 人/21 人，28.6%；故醫療黏性損傷發生率及嚴重程度明顯 因介入措施獲得改善；且在護理人員使用醫療黏膠之照護正確率查檢中，其正確率有顯著之提升由45.8% 提升至86.1%。若能將預防醫療黏膠之相關損傷之相關課題，及正確操作技巧等臨床照護指引，納為新進 護理人員及護理人員之教育訓練與評值項目，並列為重症單位品管指標之監測項目，使每位重症護理師 重視此議題，於病人一入院時就識別病人是否為醫療黏性損傷之高危險群，運用預防照護指引及臨床單 位可使用醫材，必能使醫療黏性損傷降至最低。

The aim of this study was to assess the effect of the intervention on critical patients after medical adhesive related skin injuries (MARSI) in ICU setting. We assessed the rate, severity and application the correctness of adhesive use of nurse for patients suffering from MARSI in ICU from January to March 2014. Through intervention during April to October 2014, which included introducing protocol for applying medical adhesives, method of application guideline, patient skin protection guideline, education for nurses for atrisk skin assessment, and education for prevention of skin damage through tape application and removal technique. During this 12 months of study, before ivtervention a total of 189 patients /952 patient-days (19.9%), and after intervention, a total of 21 patients /585 patient-days (3.6%) suffered from medical adhesive related skin injuries (MARSI). For the severity: before intervention, a total on 117/189 patients (61.9%), and after intervention a total on 6/21 patients(28.6%) of them had second degree skin injuries. This result shows that the intervention significantly reduced the rate and severity of MARSI. Medical adhesive application correctness was also increased from 45.8% to 86.1%. In order to reduce MARSI, we recommend incorporating mandatory courses into new staff orientation and regular staff re-evaluation. It can also become an item for quality assurance monitoring in critical care units. So that high-risk patients are identified upon triage and appropriate adhesive products and preventive guidelines are used appropriately.