降低內科病房非侵襲性正壓呼吸器壓傷發生率之品質改善計畫

Reduction in the Incidence of Pressure Injury Caused by Non-Invasive Positive Pressure Ventilation in the Medical Ward

目的：近幾年來在本單位非侵襲性正壓呼吸器(Non-Invasive Positive Pressure Ventilation, NIV)造成之壓傷比率逐年上升，造成病人疼痛、增加感染機會，也增加護理時數，甚至延長住院天數，因此期望藉由改善措施降低壓傷發生率。

材料與方法：本單位為胸腔內科病房，2017年使用NIV共281人次/年，因NIV造成壓傷比率高達48.4%。專案小組分析原因為1.缺乏NIV照護指引及審核機制、2.缺乏相關教育訓練、3.未使用保護性泡棉敷料或敷料選擇不一致、4. 未每2小時評估皮膚完整性及釋壓、5.未適度調整頭帶面罩鬆緊、6.無提供皮膚保護標準圖片、7.原固定方式不易觀察。藉由腦力激盪提出改善措施為：1.制定NIV壓傷標準作業流程；2.舉辦在職教育；3.查核照護正確性；4.購入剪裁專用尺及規範敷料；5.製作NIV照護標準圖片；6.創新NIV專用頭套。

結果：有效降低NIV壓傷發生率至13.7%。

結論：透過改善措施有效降低壓傷發生率，提升照護品質。

 

Purpose: In recent years, the incidence of pressure injury caused by non-invasive positive pressure ventilation (NIV) in our unit has increased year by year, causing pain, increasing the risk of infection and the number of nursing hours, and even increasing the hospital stay. Therefore, improvement measures must be implemented to reduce the incidence of pressure injury.

Methods: The study unit was the thoracic medicine ward. In 2017, NIV was used for 281 persontimes/year, and the incidence rate of pressure injury caused by NIV was as high as 48.4%. The task force determined the following reasons for the high incidence of pressure injury: (1) lack of NIV care guidelines and review mechanisms, (2) lack of relevant education and training, (3) no use of protective foam dressings or inconsistent dressing choices, (4) no assessment of skin integrity and pressure relief every 2 hours, (5) failure to adjust the tightness of the headgear mask appropriately, (6) no provision of skin protection standard pictures, and (7) difficulty in observing the original fixation method. The following improvement measures were proposed: (1) developing standard operating procedures for pressure injury caused by NIV, (2) conducting on-the-job training, (3) evaluating the correctness of care, (4) purchasing special tailoring rulers and standardized dressings, and (5) using NIV care standard pictures, and (6) innovating NIV special headgear.

Results: The incidence rate of pressure injury caused by NIV was effectively reduced to 13.7%.

Conclusion: By implementing the aforementioned improvement measures, we effectively reduced the incidence rate of pressure injury and improved care quality.