降低加護病房氧氣治療病人臉部皮膚壓瘡發生率

Reduce the Incidence of Facial Pressure Sore Caused by Oxygen Therapy in the Intensive Care Unit

動機：氧氣治療引起的臉部壓瘡潰瘍將會造成醫療成本增加並造成病人傷害，本病房發生率為58.7%，成立專案小組解決此問題，經現況分析後歸納問題為：未給予正確皮膚防護工具、未持續評值皮膚完整性、固定氧氣導管材質差及氣管內管固定方式未統一。解決方案：(1) 改良氣管內管管路固定方法。(2) 增設輔助防護工具。(3) 制定氧氣治療病人臉部皮膚照護指引。(4) 制定臉部壓瘡紀錄查核單。(5) 制定管路照護品質監測。(6) 舉辦在職教育訓練。結果：臉部壓瘡發生率由58.7% 下降至3.3%。結論：使用輔助防壓工具，同時針對護理同仁進行壓瘡之評估稽核制度，可有效改善氧氣治療病人臉部皮膚壓瘡之發生。

Background & Problems: The oxygen therapy may lead to the facial pressure sore which results in increased health care costs and harm to patients. The incidence is about 58.7% in our ward. Therefore, a special team was formed to solve the problems. Several causes were identified, such as improper skin protection, inconsistent monitoring of skin condition, use of nasal oxygen catheter made with poor quality material, and inconsistent fixation of endotracheal tube.
Methods: The following procedures were taken: 1. developing a standard operation of setting oxygen tube; 2. adding new protection tools to prevent pressure sore; 3. developing guidelines of facial skin care for patients receiving oxygen therapy; 4. making a checklist for injuried patients; 5. monitoring the quality of care; and 6. conducting an in-service education program.
Results: After implementation of these procedures, the incidence of facial pressure sore decreased from 58.7% to 3.3%.
Conclusion: These proposed procedures showed efficacy of reducing pressure sore. Tt is recommended that these procedure can be integrated into the care system.