降低早產兒裝置鼻式連續性氣道正壓呼吸器導致鼻黏膜出血之專案

The Improvement Program to Minimize Nasal Bleeding Caused by Nasal Continuous Positive Airway Pressure (NCPAP) Treatment in Preterm Infants

早產兒使用鼻式連續性氣道正壓呼吸器來促進肺泡擴張是常用的呼吸治療方式，而鼻黏膜出血為最常見的合併症。本單位於2014／1／1～8／1發生中度鼻黏膜出血發生率高達60％，因此引發改善專案之動機，經現況分析後歸納問題為：護理人員缺乏早產兒裝置NCPAP的相關照護知識、未制定NCPAP裝置流程圖、稽核制度及相關在職教育。本專案的目的為降低鼻黏膜出血發生率，提升護理人員照護能力，解決策略為重新更新NCPAP照護標準作業流程及制定NCPAP裝置流程圖、安排在職教育課程、定期執行品管監測、製作抽痰壓力提醒卡及人工皮剪裁範例、鼻導管型號選擇圖表，並重新製作固定呼吸管路帽帶，推行改善後鼻黏膜出血發生率降由60％降至15％，大幅提升病人的照護品質，於護理業務方面建議將來能有固定人員定期執行品管監測，並納入年度計畫重要指標內。 Nasal Continuous Positive Airway Pressure (NCPAP) Therapy is a common treatment to for patients with breathing problems. In the case of preterm infants, NCPAP is often used to keep the alveoli open and expand the lung's surface area for ventilation. During NCPAP treatment, the complication of nasal bleeding is commonly seen. In the period between January 1, 2014 and August 1, 2014, we observed that more than 60% of the infants suffering from nasal bleeding as a consequence of NCPAP treatment. Such high percentage motivated us to find the solution to minimize the risk of nasal bleeding with NCPAP treatment. After further analysis, we concluded several factors contributing to the high nasal bleeding implication rate, including the lack of the proper training for the use of NCPAP in preterm infants, the lack of correct understanding and awareness of the implication of NCPAP treatment, the lack of a flow chart for NCPAP therapy, and the lack of an audit system to monitor the treatment process. To solve the above problems, several measures were undertaken, including updating the standard procedure of NCPAP treatment, establishing a correct NCPAP flow chart, arranging training courses, and monitoring the quality of the treatment and service. After implementation of the measures, the nasal bleeding rate after NCPAP treatment has significant decreased from 60% to 13%. We would highly recommend frequent and constant audits to improve the service and treatment quality. It is also important to include the audit as one of the key elements in the annual review.