降低小兒加護病房醫療黏性產品相關皮膚損傷之發生率

Decreasing the Incidence of Medical Adhesive-Related Skin Injuries in a Pediatric Intensive Care Unit

背景：因疾病、皮膚結構變化、藥物或黏貼與移除醫療黏性產品手法、技巧錯誤，可能造成黏貼處皮膚產生損傷，本單位發生率高達12.5％，增加照護難度及成本，因此引發執行此專案動機。經現況分析，主要原因包括：醫療黏性產品使用不正確、缺乏預防醫療黏性產品皮膚損傷相關教育訓練及缺乏皮膚損傷之照護流程。目的：本專案目的在降低小兒加護病房醫療黏性產品相關皮膚損傷（medical adhesive-related skin injury, MARSI）之發生率。解決方案　透過舉辦教育訓練，教導黏貼與移除醫療黏性產品的技巧|建立照護共識並修訂單位內照護流程|制定稽核機制，提升執行成效。結果：專案實施後，醫療黏性產品相關皮膚損傷發生率由12.5％降至5.18％。結論：透過教育訓練、示範與回覆教學、修訂照護流程與不定期稽核，能確實降低MARSI之發生率。未來將協同各團隊成員持續推展與預防MARSI，使皮膚照護之品質更臻完善。

Background & Problems: Medical adhesives are typically used to fix wound dressings and catheters in place. Medical adhesive-related skin injuries (MARSI) are frequently caused by repetitive or improper usage of these products. The incidence rate in this unit is as high as 12.5%, which increases the difficulty and cost of care. After analysis of the situation, we identified the main causes of MARSI in our unit as: (1) Inadequate use of medicaladhesive products, (2) Lack of relevant education and training to prevent MARSI, and (3) lack of a standardized skindamage-care procedure. Purpose: To decrease the incidence of MARSI in the pediatric intensive care unit. Resolution: A training program was enacted to teach proper medical-adhesive application and removal techniques to caregivers. Consensus on care procedures was reached and care standards were modified. A mechanism for quality control was established. Results: After implementing the program, the incidence of MARSI dropped from 12.5% to 5.18%, which achieved the target of this project. Conclusions: Other caregivers at our institution remain unaware of MARSI prevention techniques and protocols. We plan to continue cooperating with other staff members to prevent MARSI and to continue to reduce related skin injuries to as close to nil as possible.