運用組合式照護降低外科加護病房病人失禁性皮膚炎發生率

Applying the Bundle Care to Reduce the Incidence of Incontinence Associated Dermatitis among Surgical Intensive Care Unit Patients

加護病房病人發生失禁性皮膚炎會造成病人感染，引發敗血性休克的風險，本單位失禁性皮膚炎發生率為19.6%，問題為護理人員認知及技能正確性不足、照護方式不一、缺乏輔助評估工具、無稽核機制，引發動機專案，改善外科加護病房失禁性皮膚炎發生率。藉由舉辦「失禁性皮膚炎照護工作坊」情境模擬操作，製作「柔嫩肌膚，ABCD」教學影片，使用「潔屁保膚－黏來配」評估圖卡作為交班工具，制定「失禁性皮膚炎照護標準及查核機制」等方案，改善後失禁性皮膚災發生率由19.6%降至3.6%，護理人員認知正確率由65.3%提升至94.7%，預防與照護正確率由66.2%提升至100%。本專案依據文獻擬定失禁性皮膚災之維合式照護標準，經提供多元教學後，提升護理師照護能力，降低失禁性皮膚災發生。

Intensive care unit (ICU) patients suffering from incontinence-associated dermatitis (IAD) may lead to patient infection, resulting in septic shock. The incidence of IAD in our ward was 19.6%. We identified problem included inadequate knowledge and skills among nursing staff, inconsistent care process, lack of assessment tools, and absence of internal clinical auditing. These finding led to development of a quality improvement project designed to reduce the incidence rate of IAD in our surgical ICU. Through conducting the IAD care workshop with scenario-based simulations, creating the instructional video“Care Skin, ABCD”, utilizing the“Clean Perineum, Skin Protection - Sticky Pay”assessment card as a handover tool, and establishing“IAD care standards and internal clinical auditing”, the incidence of IAD decreased from 19.6% to 3.6%, while the accuracy rate of nurses’knowledge improved from 65.3% to 94.7%. Furthermore, the accuracy rate of prevention and care increased from 66.2% to 100%. This project develops bundle care for each grade of IAD skin based on the evidence studies. Implementation of a multifaceted educational intervention targeting the nursing staff resulted in enhanced competencies in managing incontinence-associated dermatitis (IAD), which subsequently led to a notable decline in the incidence of IAD among patients in the surgical intensive care unit.