提升主要照顧者管路照護回覆示教之完整率

Improve the Integrity Rate of Response and Teaching for Tube Care Administered by the Primary Caregiver

背景：疾病或是長期臥床導致病人需留置鼻胃管、尿管、氣切管（簡稱三管）與日俱增，正確照護才能維持管路原有功能；倘若照顧不當，使管路滑脫、阻塞、感染，嚴重可能引發敗血性休克，危及生命。目的：提升主要照顧者對三管照護回覆示教之完整率，進而提升照護品質。解決方法：於2019年2月10日至3月31日期間查核主要照顧者對鼻胃管、導尿管、氣切管照護回覆示教之完整率低，分別為42.5％、38％、58.3％，主要原因：（一）人員：溝通不良、忘記照護步驟、沒時間學、不敢做鼻胃管旋轉。（二）工具：衛教單張無圖示。（三）政策：缺乏標準、稽核。故製作創新實體衛教工具、多國語言三管照護影片及圖卡、導尿管固定束帶，以及主要照顧者三管照護回覆示教標準與稽核制度。結果：主要照顧者鼻胃管、導尿管、氣切管照護回覆示教之完整率分別提升到97.3％、96.3％、95％。結論：藉由創新衛教輔助工具，病人出院後，主要照顧者無護理師在旁，亦可跟著影片完成正確照護步驟，達三管照護完整性。

Background & Problems: The need to use an indwelling nasogastric tube, urinary catheter, or tracheostomy tube (the so-called ''three tubes'') because of illness or prolonged bedrest is increasing. The functions and effectiveness of these tubes may be maintained only with correct care. Improper care, slippage, obstruction, or infection may in severe cases cause septic shock or even death. Purpose: To increase the completeness of the reverse demonstration of three tubes care instructions by primary caregivers to further improve related care quality. Resolution: Between February 10th and March 31st, 2019, the completeness rates of reverse demonstration of nasogastric tube, urinary catheter, and tracheostomy tube care instructions among the primary caregivers participating in this study were shown to be low, at 42.5%, 38%, and 58.3%, respectively. The plausible causes were: 1. Human: Poor communication, forgetting the care steps, having no time for learning, and fear of performing nasogastric tube rotation; 2. Instrument: Lack of graphic demonstrations in health education materials; 3. Policy: Lack of standards and auditing. The implemented intervention involved creating innovative health-education instruments, videos and flash cards about three tubes care in multiple languages, and straps for holding the urinary catheter and developing standards and an auditing system for the reverse demonstration of three tube care instructions by primary caregivers. Results: The completeness rates for the reverse demonstration of nasogastric tube, urinary catheter, and tracheostomy tube care instructions among the primary caregivers improved to 97.3%, 96.3%, and 95%, respectively. Conclusions: Using the innovative health-education aids and improvements introduced in this study, the ability of primary caregivers to correctly perform the care steps should improve significantly.