運用''SAFE''教育方案於吞嚥功能障礙個案居家照護之改善方案

An Improved Program for the ''SAFE'' Education Protocol for Impaired Swallowing in Patients Receiving Home Care Services

吞嚥困難個案若未經吞嚥訓練，易因嗆咳導致吸入性肺炎、營養失調等合併症及增加死亡率。發展教育方案提升居家個案吞嚥訓練執行率，評值居家吞嚥功能障礙個案之成效。現況分析：發現護理師吞嚥功能評估認知僅61.8%，2015年11月~2016年6月23位收案對象吞嚥功能，吞嚥訓練居家執行率僅21.7%，分析原因：缺乏吞嚥訓練標準作業流程、缺乏吞嚥訓練篩檢表、查核、訓練知識與技巧、缺乏中印尼文衛教單張。研擬解決方案：制訂吞嚥訓練規範與查核表，中印尼文吞嚥訓練衛教單及多媒體影片。護理師吞嚥評估認知提升至92.3%，2016年10月至2018年1月依量表評值23位個案，21位(91.3%)提升至少一個層級。運用''SAFE''教育方案協助個案在安全環境下進食，減少發生嗆咳，協助部分個案移除鼻胃管，提升照護品質。

Dysphagia, which is difficulty swallowing caused by several disease that affect the nervous system, oral and esophageal cancer, and GERD, can lead to some nutrition imbalance as well as chest infections including aspiration pneumonia and choking, both life threatening. The purpose of this project was to promote the swallowing ability and functional evaluation (SAFE) education protocol among homecare service personnel and assess the effectiveness education program on caretaker improvement impaired swallowing in patients receiving home care services. Caretakers were assessed for knowledge of swallowing function and use of swallowing training protocol. Swallowing function initially assessed in 23 patients diagnosed with dysphagia from November 2015 to June 2016 and later assessed in 23 patients October 2016 to January 2018. Initial assessed of caretakers revealed that only 61.8% of them understood swallowing function and only 21.7% practiced swallowing training in their home care services due to lack of standardized swallowing training procedures, related knowledge and skills, and related educational resources. To solve these problems, we formulated standardized swallowing training programs and checklists, patient information leaflets in both Chinese and Indonesian, and educational media. After training, 92.3%. of the caretakers demonstrated adequate knowledge of swallowing function and 21 of 23 patients (91.3%) increased by at least one level in swallowing function score. The“SAFE”education protocol improved the safety of patients with dysphagia, decreased the incidence of choking and the need for nasogastric tubes, and improved the quality of home care services.