住院及需長期管灌老人之營養與照護品質提昇計畫

Nasogastric tube feeding in hospitalized elderly patients: Toward good practice

住院病患當無法由口進食時，須經由鼻胃管灌食方式給予，以提供適當的營養，而灌食老人之營養評估需包含管灌食品的成份、總熱量攝取情形，以及生化檢驗報告與整體性身體評估技巧的應用。管灌老人營養不足的現象常因照顧者之管灌知能不足，護理人員在執行營養照顧之衛教過程中，需要充份了解照顧者之照護經驗、認知程度以及衛教單張使用的適切性，而有效的溝通管道與隨時評價護理成效，也是提升照護品質的重要關鍵。本專案主旨乃在提升住院及需長期管灌老人的管灌照顧以及營養狀況。本方案內容包括：制定及使用管灌記錄單與檢核表並加上改善管灌衛教方式；建立定期追蹤及管理照護的機制，以增進主要照顧者在管灌技術執行上的正確率。藉由本文之發表，希望能提供長期照護實務工作者的參考。

Eating by mouth is the preferred method for patients and should be used whenever possible, but some elderly patients may not be able to take any or enough food by mouth due to complications from medical conditions (e.g., stroke/frailty) or medical therapies (e.g., pharmaceutical or surgical therapies). In hospitalized elderly patients, malnutrition may be caused by inadequate feeding or unsuitable feeding, which can have far-reaching biological and physical impacts among them. Early nutrition assessment, including physical examination, laboratory tests, and anthropometric measurements, is essential to identify and target elderly patients and their caregivers for further intervention. The purpose of this study is to focus on these patients receiving nasogastric tube feeding, review the composition of the formulas for feeding, and develop a set of educational instructions and materials related to nutritional care for their caregivers. The results from this study will be of significant value in promoting the physical health of the elderly, improve the quality of care to meet their nutritional needs, and promote knowledge of relatives in their delivery of day-to-day care.