提升高齡照顧者執行鼻胃管灌食照護正確率

Improvement of the Accuracy Rate of Correcting Nasogastric Tube feeding Care Among Elder Family Caregivers

鼻胃管對於意識不清、吞嚥困難、易嗆咳的病人是長期重要的營養支持管道，具安全且感染併發症低，但經統計本單位鼻胃管灌食併發症導致的死亡率卻佔4.3%，故引發此改善動機。經現況分析發現主要原因為，護理人員衛教內容不一致及缺乏對高齡照顧者篩選條件的認知，所以未正確辨別高齡者需求，沒有標準化流程、沒有衛教單張、沒有適當的衛教工具及沒有評值查核表，無照護諮詢專線稽核追蹤學習成效，故擬定：制定高齡篩選表、標準化流程、根據高齡衛教原則客製「不 NG 灌食衛教套組及每日衛教時程模組」及建立照護諮詢專線稽核追蹤學習成效，為本專案之解決方案。經專案改善後，高齡照顧者鼻胃管灌食認知、技能正確率分別由 59.1% 及 66% 提升至 96.2% 及 96.6%。本單位經實施提升高齡照顧者執行鼻胃管灌食照護正確率專案後，除降低鼻胃管灌食併發症，亦將死亡率降至 0%，達成提升高齡照顧者執行鼻胃管灌食照護正確率的目標並且落實病人居家安全，期望此專案可作為日後臨床護理人員參考，強化衛教的功能且更凸顯其重要性。

Nasogastric tube (NG) feeding is a comparatively safe method, with low risk of infectious complications, for providing long-term nutrition support to patients who are unconscious, susceptible to choking or with dysphagia. However in the department where the author serves, NG feeding-related complications account for as high as 4.3% of patient deaths. Hence this project was designed to improve the accuracy of senior caregivers’ nasogastric tube feeding. Analysis shows that the major causes of NG feeding -related complications in senior patients were caregivers’ failure to identify the needs of patients, and the lack of appropriate health education tools, standardized health education procedures and an auditing system. The approaches applied to improve NG feeding accuracy of senior caregivers included: a) developing a senior patient screening sheet, b) developing customized non-NG feeding education sets and a daily education schedule module as well as a standardized procedure based on the principles of health education for senior patients, and c) establishing an information and consultation system to audit and follow up senior caregivers’ learning outcomes. As a result, the accuracy of the senior caregivers’ NG feeding knowledge and skills has been improved from 59.1% to 96.2% and from 66% to 96.6% respectively; and the death caused by NG feeding-related complications has dropped to 0%. This project achieved the goal of improving the NG feeding skills of senior caregivers and enhancing patient safety. The results of this project serve provide clinical reference for future patient care.