降低腦中風病人口腔照護不完整率之改善專案

Improving the Completeness of Oral Care for Stroke Patients

腦中風佔臺灣十大死因第四位，良好口腔照護能減少吸入性肺炎。本病房發現執行口腔照護不完整率達47.1％，引發改善動機旨在降低腦中風病人口腔照護不完整率。分析不完整原因為口腔檢查項目太多、不知道記錄口腔病兆、認為放置鼻胃管不需執行、工作忙碌、認為是主要照顧者的責任、與復健時間衝突、不知道口腔護理步驟、病人意識不清難配合、家屬認為不需要。解決辦法：張貼衛教單張和推廣口腔清潔影音QR Code、舉辦在職教育、修訂新進人員訓練手冊、舉辦團體衛教和口腔衛生好寶寶選拔。經專案改善後不完整率下降至8%。將衛教單張和口腔清潔影音QR Code推廣至其他病房，以提昇照護品質。

Stroke is the fourth most common cause of death in Taiwan. Good oral care can reduce aspiration pneumonia. In the ward under study, the rate of incomplete oral care was 47.1%; therefore, this study sought to improve the completeness of oral care rate among brain stroke patients. An analysis revealed the following reasons for incomplete oral care: (1) the item checklist being too long; (2) no record existing of the symptoms of oral diseases; (3) refusing the placement of nasogastric tubes; (4) being too busy to work; (5) arguing that taking care of patients is the responsibility of the primary caregiver; (6) conflicts existing with rehabilitation time; (7) confusing the steps of oral care; (8) experiencing difficulty in cooperating with patients with clouded consciousness; and (9) the patient's family not thinking complete oral care is necessary. This study proposed the following solutions: (1) posting health education leaflets and promoting the QR code for a video about oral care; (2) promoting on-the-job training; (3) providing training manuals for new recruits; (4) organizing group teaching and oral hygiene contests. After the improvements, the rate of incomplete oral care decreased to 8%. Therefore, promoting health education leaflets and the QR Code for the video on oral care to other wards can enhance their quality of care.