運用多元策略降低外科病人返家後腹部引流管照護異常率

Multiple Strategies to Reduce Incidence of Abdominal Drainage Tube Care after Surgical Patients Return Home

外科病人留置引流管返家主要目的為持續引流，降低引流液對周圍器官的刺激及促進傷口癒合或達到治療效果，近期發現出院病人來電諮詢引流管照護問題件數增加，並接獲醫師反應病人返家後未記錄引流量、引流管固定鬆脫、滑脫或阻塞等事件，因此希望分析現行作業問題，找出有效改善策略。調查2019年1-3月病人返家後引流管照護異常率15.4%，分析原因為護理人員執行引流管自我照護指導完整性僅89.6%、病人執行引流管自我照護正確性僅79.7%、決定帶引流管返家時機太晚，來不及指導及練習自我照護方法及缺乏引流管照護衛教單張。解決方法包含建立引流管照護指導確認卡、修訂引流管照護方式、製作引流管照護衛教影片、舉辦引流管自我照護訓練、建置引流管居家遠端照護系統，監控返家後引流管照護情況、建立居家引流管留置評估標準及製作引流管自我照護卡。改善後護理人員執行引流管自我照護指導完整性提升至100%、病人執行引流管自我照護正確性提升至100%、病人返家後引流管照護異常率降低至1.4%。施行效果良好平行展開至其他外科病房。因應大數據時代的來臨，建議未來能將居家遠端照護系統上之資料，建立資料庫分析並發展成預測系統，提供醫療照護上之決策參考。

The purpose of keeping drainage tubes after discharge from hospital is to continue drainage and reduce the stimulation of the drainage fluid to nearby organs around the surgical site and speed wound healing or achieve therapeutic outcomes. Recently, the number of discharged surgical patients calling for consultation on drainage tube care problems has increased, and doctors have reported that the patient did not record the amount of drainage, loosening, or slippage or blockage of the drainage tube after discharge. Therefore, the researcher analyzed current operation problems and developed effective improvement strategies.
The researchers analyzed the abnormal rate of drainage tube care of discharged surgical patients from January to March 2019. Causes revealed from analyses include completeness rate of nursing staff performing drainage tube self-care instruction was 89.6%; correct rate of patients performing drainage tube self-care was 79.7. %; being too late to decide taking drainage tube home and to instruct and practice self-care methods, and lack of a leaflet on drainage tube nursing care. Solutions include developing a drainage tube care guidance confirmation card, revising drainage tube care techniques, making drainage tube care and health education videos, holding drainage tube self-care training, building a drainage tube home remote care system, and monitoring the discharge drainage tube care, developing evaluation criteria for indwelling drainage tube at home and make the self-care card for drainage tube.
After the improvement, the completeness rate of nursing staff performing drainage tube self-care instruction as well as the correct rate of patients performing drainage tube self-care instruction increased to 100%. The abnormal rate of drainage tube care of discharged surgical patients decreased to 1.4%. The implementation outcome was ideal and the program was carried out in other surgical wards. Following the evolution of big data era, data on the remote home care system can be developed into a database for analysis and transformed to a predictive system that provides references for medical care decision-making.