建立慢性阻塞性肺疾病急診出院病患護理指導模式之專案

The Project of Establishing Nursing Instruction Structure for Discharged COPD Patients in Emergency Department

近年來老年人口急速增加、慢性病盛行，急診慢性病留觀人數增多，回診率偏高，故衛生署積極推動出院準備服務計畫，提供兼具成本效益與優質的照護，遂引發本專案的動機。根據某醫學中心急診留觀病患診斷分佈發現，慢性阻塞性肺疾病（COPD）病患人數佔首位（39.5％），故選定COPD病患為加強護理指導的對象。本專案執行三個月共收案39位，衛教前-後測正確率由26.9％提昇至80％，目標達成率為100％，進步率為197％。整體滿意度平均為4.34分，助益性平均為4.26分。平均滯留時間為23.16小時，7日內再回診率也由17.6％降為15.4％。顯示本專案不但能強化護理人員對COPD知識瞭解，增加病患自我照顧能力，減少反覆就醫頻次，進而提昇居家生活品質。

In recent years, the chronic diseases of aging people are quickly increasing. Because of theirhigh revisit rate and high cost of medical care, how to combine cost effectiveness and quality careis the underlying motivation for this project. According to results of a prior investigation in ER,COPD patients were the majority of the emergency observation patient(39.5%), therefore, theCOPD patients were adopted for the first choice of nursing instruction in this project. This projectwas running 3 months and observed 39 cases, and the outcome of this project included the correctrate of self-care knowledge in COPD patients elevating from 26.9% to 80%. The rate for targetreaching was 100% and progress rate was 197%. The average score of patient's satisfaction withthe nursing instruction was 4.34, and the score for the helpfulness was 4.26(the full score is 5). Theperiod of stay was also shortened to 23.16 hours, and the revisit rate within 7 days was decreasedfrom 17.6% to 15.4%. All these prominent outcomes of this project can enhance the self-careability of the COPD patients and decrease the frequency of revisit rate, and can further improve thepatients' daily life quality.