PADIS應用於重症照護降低管路滑脫異常事件之改善方案

Applying PADIS to Reduce Unplanned Extubations in Intensive Care Units

加護病房非計畫性管路滑脫會延長住院天數、提高醫療成本，增加死亡率，統計台灣南部某醫學中心外科加護病房2019年管路滑脫異常發生率0.11%，本專案目的降低非計畫性管路滑脫異常事件。分析導因：缺乏躁動病人預防規範、無躁動與譫妄處置指引；躁動-鎮靜量表評估工具警示系統不足、無譫妄與躁動鑑別評估工具；病人因插管痛、口渴、喉嚨異物感無法表達；護理師不知如何運用評估工具、翻身前未雙重確認管路，運用臨床常見疼痛、躁動、譫妄、制動、睡眠（Pain、Agitation、Delirium、Immobility、Sleep, PADIS）管理策略，對策實施PADIS照護課程、作業流程修訂標準、優化表單、資訊、溝通圖卡、製作PADIS工具書，專案實施後管路異常發生率由改善前0.11%降至0.05%，建議推廣PADIS管理策略，提升重症照護品質。

Unplanned extubations in intensive care units lead to increased length of hospital stay, medical costs, and mortality. A statistical analysis of a surgical intensive care unit in a medical center in southern Taiwan revealed an abnormal incidence rate of 0.11% for unplanned device dislodgement in 2019. and thus the goal of this project was to reduce said incidence. Analyses revealed that unplanned extubations are caused by a lack of preventive guidelines for agitated patients and guidelines for managing agitation and delirium. A warning system based on the Richmond Agitation-Sedation Scale assessment was lacking, and no instrument was in place for distinguishing delirium and agitation. Patients have been unable to express themselves because of postintubation pain, thirst, foreign body sensation in the throat, and difficulty speaking. Nurses did not know how to use assessment tools and failed to double-check the tube before turning patients over. This project adopted the commonly used pain, agitation, delirium, immobility, and sleep (PADIS) management strategy to implement a PADIS nursing course; establish a standard operating procedure; optimize forms, information presentation, and communication cards; and produce a PADIS manual. These measures reduced the incidence of unplanned extubations from 0.11% to 0.05%. Accordingly, the PADIS management strategy is recommended for improving the quality of critical care.