降低加護病房使用非侵襲性正壓呼吸器病人之顏面壓傷發生率

Reducing the Incidence of Facial Pressure Injury Caused by Non-Invasive Positive Pressure Ventilation in Intensive Care Unit

近年來，使用非侵襲性正壓呼吸器常導致加護病房病人發生顏面壓傷，不僅讓病人遭受疼痛且造成家屬質疑本單位照護品質。於2020年統計單位病人顏面壓傷發生率為2.8%，有逐漸升高趨勢，遂成立專案改善小組，以期望降低使用非侵襲性正壓呼吸器病人顏面壓傷之發生率。經現況分析，發現原因為：單位無照護標準規範及稽核機制、缺少裁剪與防壓輔助工具、護理人員對壓傷與防壓照護新知缺乏。藉由文獻查證及團隊討論後，制訂照護標準規範、建立照護品質查核表並進行稽核、製作臉部防壓提醒與壓傷標記圖卡、創新設計一體成型之敷料裁剪模板及加強人員的教育訓練與穿戴演練等。顏面壓傷發生率由2020年2.8%降至2021年改善後的1.0%達目標。期望藉本專案之成功經驗提供其他單位參考，減少病人因醫療裝置造成的傷害，全面提升整體照護品質。

The use of noninvasive positive pressure ventilation (NIPPV) in intensive care units has led to more frequent occurrence of facial pressure injuries, which cause discomfort for patients and raise concerns in their families regarding the quality of care provided. The incidence of facial pressure injuries was 2.8% in 2020, and the trend in these injuries was upward. A quality improvement project was initiated to reduce the incidence of facial pressure injuries caused by NIPPV. Through the evaluation and analysis of clinical situations, the following problems were identified: an absence of established nursing care standards and inspection protocols, a lack of specialized cutting and antistress tools, and inadequate knowledge on pressure injuries and preventative care measures. In addition, we conducted a literature review and team discussion. The intervention maneuvers decided upon included the formulation of nursing standards and specifications, establishment of nursing quality checklists and conduction of audits, creation of facial antipressure reminders and design of marking cards, innovative design of integrated dressing cutting templates, provision of on-the-job educational training, and strengthening of staff’s proficiency in installation and removal procedures for NIPPV. After the intervention, the incidence rate had decreased significantly from 2.8% in 2020 to 1.0% in 2021. The aforementioned effective strategies can be used as a reference for other units to reduce injuries caused by medical equipment and comprehensively improve the overall quality of care.