降低外傷急症加護病房病人壓力性損傷發生率

Reducing Incidence Rate of Pressure Injury for Patients in Trauma Intensive Care Unit

壓力性損傷發生率是醫療照護品質重要指標。本單位為外傷急症加護病房， 2016 年 1 月至 12 月單位壓力性損傷發生率達 1.20%，遠高於本院閾值 0.07%，亦遠高於其他醫學中心同儕年壓力性損傷發生率 0.25%，故成立專案改善小組。調查發現導致單位壓力性損傷發生率上升的原因為護理人員對壓力性損傷預防照護認知與行為正確性偏低，並且單位缺乏高危險病人提醒機制、雙向諮詢回饋管道、有效翻身輔具及教育訓練。經專案小組設計預防壓力性損傷照護策略、運用通訊軟體建立雙向溝通平台、使用改良式翻身輔具與 C 型海綿圈及舉辦教育訓練等改善措施介入後，外傷急症加護病房壓力性損傷發生率降低至 0.05%，護理人員壓力性損傷預防照護認知正確率由63.6%提升至94.9%，而行為正確執行率由52.3%提升至93.8%。冀望藉此專案提供同仁參考，以共同提升加護單位的護理照護品質。

The pressure injury incidence is regarded as an important indicator of quality of medical care. The authors work in the Trauma Intensive Care Unit (TICU). From January to December, 2016, the pressure injury incidence rate in TICU was 1.20%, which was much higher than the standard rate (0.07%), and also higher than the national incidence rates of pressure injuries in medical centers (0.25%) at the same year. Therefore, the task force of improving the incidence rate of pressure injury was established. The task force surveyed factors that caused the high incidence of pressure injury in the unit. They included insufficient knowledge and performance of nursing staff about care and prevention of pressure injury, lack of proper bedside high risk identification system and digital platform for patient evaluation, and inadequate equipment for patient repositioning and on-job training program. Accordingly, the task force designed and implemented an improving protocol, including: establishing pressure injury care prevention policies, setting up a digital platform for patient evaluation, providing adequate equipment for body repositioning, offering ''C'' shaped foam cushions, and creating a training program for nursing staff. As a result, the incidence rate of pressure injury successfully reduced to 0.05%. The accuracy and performance of pressure injury prevention and care were enhanced from 63.6% to 94.9% and 52.3% to 93.8%, respectively. The result of this project can serve as a reference for pressure injury prevention in clinical settings and promote the quality of patient care.