降低某區域醫院內科病房病人壓力性損傷發生率

Reduce the incidence of pressure injuries in the medical ward of a regional hospital

長期臥床易衍生壓力性損傷問題，壓力性損傷的發生，將增加照護的難度及住院天數，更可能造成醫療費用的增加。本院某2處病房主要收治內科住院病人，且以長期臥床之制動病人為主（占86.40％），需仰賴護理師與照服員執行壓力性損傷之預防與照護。進一步調查，此2處病房壓力性損傷發生率0.139％，高於其他病房及台灣醫療照護品質指標系列（Taiwan Healthcare Indicator Series, THIS）同儕值，故以品管圈進行改善，並參考THIS指標同儕值訂立改善目標降至0.058％。為瞭解病人壓力性損傷成因，小組進行現況調查與原因釐清並參考文獻，提出六大改善1.製作翻身提醒圖卡；2.增加照會流程與監測機制；3.制訂翻身擺位技術標準；4.自創「關支零」；改善「L枕」輔具；5.製作預防衛教單與衛教指導影片6.定期舉辦相關在職教育。結果有效改善壓力性損傷發生率降至0.038％。

Long-term bedridden patients are at higher risk to develop pressure injuries, which may result in management difficulty, prolonged length of hospital stay and increased medical costs. In this study , two medical wards were included. Most patients in these two wards are long-term, bedridden, immobilized patients (86.40%) who require protective and preventive measures against pressure injuries usually carried out by nurses and caregivers against pressure injuries. Further investigation shows that the incidence of pressure injury in these wards is 0.139%, which is higher than that of other wards and the standard of Taiwan Healthcare Indicator Series (THIS). Hence we initiated improvement measures and set our goal at 0.058%, based on THIS peer incidence. We investigated the current status and the cause of pressure injuries in patients, and conducted literature reviews. We proposed six improvement strategies: a) create illustrated reminder card for reposition, b) establish consultation procedure and monitor system, c) establish standards of turning and positioning, d) produce self-designed assistive device ''KZL'' and improve L-shaped pillow, e) produce health education leaflet and instruction video, and f) conduct regular on-the-job training. As a result, the incidence of pressure injury reduced to 0.038%.