降低血液腫瘤病房壓力性損傷之發生密度

Reducing the Incident Density of Pressure Injury in Hematology-Oncology Wards

血液腫瘤科病人因化療或骨髓移植後免疫抑制，易因體能虚弱臥床時間長，單位壓力性損傷發生 密度由 2013年 0.17%上升至2014年 0.30%，故期望藉專案推動有效降低壓力性損傷發生密度。分析導因 為：（1）護理師對壓力性損傷護理認知不足；（2）護理師壓力性損傷分級判定能力不足；（3）護理師壓力性报 傷照護執行不足；（4）本單位防壓輔具設備不足。經加強在職教育及培育種子人員，提升護理師對壓力性 損傷預防相關認知及操作能力，建立壓力性損傷照護查核機制，即時介入適當的防壓措施輔具，利用翻 身擺位圖片單張或影片，提升指導效能，並善用跨領域團隊合作資源，壓力性損傷發生密度可由改善前 平均0.30%下降至0.12%，可達目標值且效果維持成效良好，有助於提升壓力性損傷護理品質。

Patients at the hematology-oncology wards are prone to develop pressure injury because of frailty due to prolonged bed-ridden status, which was a result of immunosuppression by chemotherapy or bone marrow transplantation. In out unit, the density of pressure injury increased from 0.17% in 2013 to 0.30% in 2014; therefore, we thus expected this project could effectively reduce the occurrence of stress injury. Causes of this situation included: (1) A lack of awareness and knowledge regarding pressure injury. (2) Insufficient skills for assessing and staging pressure injury. (3) Poor execution of necessary procedures for preventing pressure injury. (4) Inadequate injury-preventing devices. Strategies of improvement included intensification of on-job training for staff members and trainers, enhancement of knowledge and skills related to injury prevention, auditing of injury-preventing practices, timely intervention with pressure-preventing devices, improvement of education efficacy by applying relevant diagrams, pictures and videos, and employment of multidisciplinary team resource management. These strategies reduced the density of pressure injury from 0.30% to 0.12%, which reached the goal and was well sustained. We concluded that our program provides evidence and useful guidance to enhance the quality of nursing care for the prevention of pressure injury.