運用團隊合作降低失禁性皮膚炎發生率

Using Teamwork to Reduce the Incidence of Incontinence-Associated Dermatitis

背景：2016年7－12月單位病人發生皮膚受損共386人，其中因失禁導致皮膚炎佔55％（211人），而2017年3、4月發生率仍達40.3％，顯示問題之重要性。調查顯示預防失禁性皮膚炎及照護之認知僅達78.9％，預防病人失禁性皮膚炎及照護正確性僅達58.2％，分析主要原因包含：照護執行不正確、未與醫療團隊討論、無失禁性皮膚炎照護規範及在職教育訓練、缺乏相關預防失禁性皮膚炎設備、單位病人特性及藥物等。目的：失禁性皮膚炎發生率由40.3％降至32.0％。解決方案：制訂高危險失禁性皮膚炎評估表、修訂預防失禁性皮膚炎照護標準流程、製作「風隔潔簡（air, barrier, cleansing, diaper）」提醒小卡、寶屁盒、小尿片創意包覆法及舉辦在職教育訓練、跨團隊共同照護、定期稽核。結果：經由專案實施改善後，照護失禁性皮膚炎認知由78.9％提升至95.7％，照護正確性由58.2％提升至91.5％，失禁性皮膚炎發生率於2017年11月已降至18.5％，達專案目標，持續追蹤3個月失禁性皮膚炎發生率已降至17.9％。結論：藉由制訂照護流程及與醫療團隊人員共同合作、提供創意照護措施，有效降低失禁性皮膚炎發生率，增進整體照護品質。建議院方修訂成人失禁性皮膚炎相關規範，使執行照護者有所依據，統一照護流程及標準，維持病人皮膚照護品質。

Background & Problems: Dermatitis associated with incontinence was the cause of 55% of the total of 386 skin lesion cases in our unit between July and December 2016 and 40.3% of the skin lesion cases in our unit during March and April 2017, indicating the importance of this issue. Our survey showed that the nurses in our unit scored an average of 78.9% on knowledge related to the prevention of incontinence-associated dermatitis and only 58.2% on knowledge related to incontinence-associated dermatitis care. The main reasons for the high incidence of incontinenceassociated dermatitis included: incorrect implementation of care, no discussion with the medical team, no incontinence care standards, no continue education, lack of related equipment for preventing incontinence-associated dermatitis, unit patient characteristics, and drugs used. Purpose: To reduce the incidence of incontinence-associated dermatitis from 40.3% to 32.0%. Resolution: A care-bundle in treating incontinence-associated dermatitis was implemented by designing an assessment flow chart for evaluating incontinence-associated dermatitis, by setting standard guidelines for incontinence-associated dermatitis care, by distributing reminder cards, special toolboxes, and by changing how the little diapers were wrapped. In-service education lessons, inter-professional collaborative practice, and regular internal audit were also executed. Results: After project implementation, the knowledge score of nurses increased from 78.9% to 95.7%; the correctness of care score, as retested in November 2017, increased from 58.2% to 91.5%; and the incidence of incontinenceassociated dermatitis dropped to 18.5%. These improvements achieved the goals of this project. Furthermore, the sustained effect of the project measures was confirmed, with the incidence of incontinence-associated dermatitis determined as 17.9% at three months after completion of the project. Conclusions: Formulating care procedures and cooperating with medical team personnel to provide creative care measures were shown to effectively decrease the incidence of incontinence-associated dermatitis and improve overall quality of care. The findings of this project support the revision by hospitals of regulations and procedures related to adult incontinence-associated dermatitis to provide caregivers with basis-of-care standards and uniform care procedures and standards in support of effective patient skin care regimens.