提升某外科病房居家照顧者執行鼻胃管照護正確率之改善專案

An Improvement Project to Improve the Accuracy of Nasogastric Tube Care Performed by Home Caregivers in a Surgical Ward

本文主旨為提升某外科病房居家照顧者執行鼻胃管照護正確率，鼻胃管照護若操作不當可能會造成病人發生嘔吐、吸入性肺炎等併發症，導致反覆住院，增加死亡風險，故正確的鼻胃管照護是相當重要的。臨床發現護理師進行鼻胃管照護護理衛教平均花費約15-25分鐘，指導次數約3-4次，但稽核結果顯示居家照顧者執行鼻胃管照護正確率僅71%，故引發專案動機，經現況分析調查發現居家照顧者鼻胃管照護正確率低之導因為：照顧者輪替交班內容不完整、學習時間零碎、缺乏練習機會、缺乏稽核制度、缺乏回覆示教教具。針對上述問題提出的改善策略包含：製作擬真人化之3D人型臉部模型為回覆示教的工具、制修訂鼻胃管照護查檢表、擬定3D臉部模型練習鼻胃管照護執行辦法、訂定交班指引及設立鼻胃管照護之品管指標等五項，經專案改善後居家照顧者執行鼻胃管照護正確率提升至100%，知能正確率亦可達97%，除達成本專案之目標外，亦可避免併發症產生進而提升病人安全照護品質。

The purpose of this article is to improve the accuracy of nasogastric tube care performed by home caregivers in a surgical ward. During clinical work. If the steps are wrong, it may cause complications such as vomiting and aspiration pneumonia, resulting in repeated hospitalizations, increasing the risk of death, and increasing medical costs and burdening the caregiver. It was found that the nurses spent about 15-25 minutes on nasogastric tube care and guidance, and the number of guidance was about 3-4 times. However, the accuracy rate of home caregivers performing nasogastric tube care is only 71%, which triggers the motivation of the nursing project. The reason for the low accuracy of nasogastric tube care for home caregivers is: change of caregiver but not complete handover, short of learning time, don't have practice opportunities, shortage of auditing system and implementations model. Improvement strategy: Five items including creating an anthropomorphic model for teaching, setting the nasogastric tube care checklist, executive standard, shift change guidelines and quality control index. After the improvement of the project, the accuracy rate of home caregivers performing nasogastric tube care increased to 100%.Knowledgement can increasing to 97%. In addition to reaching the goal of the project, it can also avoid complications and improve the quality of patient safety care.