提升慢性阻塞性肺病患者使用吸入性藥物正確率之改善專案

Improvement Project to Increase the Accuracy of Inhalation Drugs Use in Patients with Chronic Obstructive Pulmonary Disease

目標：COPD的吸入劑型藥劑為最常見的治療方式之一，不但可緩解症狀、改善生活品質並預防或治療急性發作，但臨床上常見老年病患因生理功能老化、操作吸入器技術不良等，造成服藥順從性下降，增加反覆入院的機會，故引發作此專案改善的動機。本專案經調查原因為病人缺乏合適衛教工具及容易忘記使用步驟、手口不協調及不清楚吸入劑重要性，造成老年病患操作MDI正確率僅69.3%。
方法：1.由專人進行一對一指導練習，利用原子筆及吸入劑空藥瓶搭配深呼吸練習吸吐及按壓。2.運用彩虹標籤貼紙標示使用步驟。3.製作定量吸入劑台語版順口溜內容參閱本。4.製作吸入劑國台語放大版操作圖片衛教海報。5.製作「臨床定量吸入劑衛教指導小幫手」。6.製作台語版、印尼語版『定量吸入劑操作』教學影音光碟、吸入劑衛教版電子書，並連結QR code供病人及家屬下載觀看學習。7.增加吸入劑團體衛教場次一個月一場。8.明訂定量吸入劑衛教指導時機。結果顯示老年病患使用MDI正確率由69.3%提昇至95.7%。
臨床應用：本改善專案成效可推廣到其他老年常見慢性疾病之護理指導，來改善護理指導完整性以提昇護理品質。

Inhalation therapy is a common treatment for chronic obstructive pulmonary disease (COPD), offering benefits such as symptom relief, improved quality of life, and prevention or management of acute exacerbations. However, clinical observations reveal that many elderly patients struggle with proper inhaler use due to age-related physiological decline and difficulties in operating inhalers. This often leads to reduced medication adherence and increased hospital readmissions, highlighting the need for this improvement project. An initial investigation found that only 69.3% of elderly patients could operate a metered-dose inhaler (MDI) correctly. Contributing factors included a lack of proper health education tools, difficulty remembering usage steps, poor hand-mouth coordination, and limited understanding of the importance of inhalers. To address the issues, we conducted one-on-one training sessions with a dedicated instructor using a ballpoint pen and an empty inhaler bottle to practice proper inhalation techniques, including deep breathing, exhaling, and pressing the inhaler; utilized rainbow-label stickers to indicate the step-by-step inhaler usage process; developed a Taiwanese version of instructional jingles to assist with MDI usage; created enlarged visual guides in Taiwanese for inhaler operation, along with health education posters; designed a ''Clinical Metered-Dose Inhaler Health Education Guidance Helper; produced multilingual instructional materials, including Taiwanese and Indonesian versions of teaching videos, audio CDs, an e-book on inhaler use, and QR codes for easy access by patients and their families; increased the frequency of group health education sessions on inhaler use to once a month; and standardized the timing for health education guidance on MDI use. Following the implementation of these strategies, the correct rate of MDI usage among elderly patients improved significantly, increasing from 69.3% to 95.7%. The outcomes of this project can be extended to nursing guidance for other chronic diseases commonly seen in the elderly. This approach enhances the comprehensiveness of nursing education, improves the quality of care, and supports better health outcomes for patients.