降低腹瀉病患臀部皮膚潰瘍之改善專案

The Proposal to Decrease the Incidence of Skin Ulceration Over the Buttocks in Patients with Diarrhea

加護病房的病患常因各種因素易有腹瀉問題，若未及時處理或護理方法不當，易造成病患臀部皮膚潰瘍，導致需延長住院時間。本專案目的在降低腹瀉病患臀部皮膚潰瘍的發生率，及建立腹瀉病患臀部皮膚潰瘍之護理標準。專案小組成員歷經資料收集、統計及分析，發現單位內平均一個月有六位病患，因腹瀉致其臀部皮膚發生潰瘍。而造成病患臀部皮膚潰瘍之主要原因包括：未建立腹瀉高危險病患群臀部皮膚潰瘍之預防護理標準、未能及時發現並更換髒濕尿布、未建立腹瀉病患臀部皮膚潰瘍護理標準及臀部皮膚清潔方式不當等。專案小組會同傷口護理師制定腹瀉病患臀部皮膚護理標準，並經宣導及病床邊示範教學後，再評值專案成效，發現單位內病患因腹瀉而致臀部皮膚潰瘍的案例數已降至平均一個月一例。藉由本專案，已能透過遵循所建立之臀部皮膚護理標準，有效降低腹瀉病患臀部皮膚潰瘍發生件數。Diarrhea may be caused by many factors in the ICU. If it was ignored or cared inappropriately, it is likely to cause skin rash or even ulceration over the buttocks, thus prolonging the patient's hospital stay and increasing the patient's and family's burden. The aim of this proposal was to decrease the incidence of skin ulceration over the buttocks in patients with diarrhea and establish nursing care standards. Data were collected by questionnaires from nurses. After analyzing by statistical methods, it was found that there were an average of six diarrhea cases developed skin ulceration every month in the unit and the factors causing skin ulceration were as follows. 1: failing to establish nursing care standards for patients who were at a high risk of skin ulceration over the buttocks; 2. overlooking and being unable to change dirty diaper immediately; 3. failing to establish the standard of caring ulceration over the buttocks or failing to clean wound appropriately. The team cooperated with the wound care nurse to establish nursing care standards for diarrhea patients. After announcement and bedside teaching, the team assessed the efficacy of this proposal and found that the incidence of skin ulceration decreased to one case in a month. The results of this proposal showed that by following the nursing care standards for high risk diarrhea patients and skin care, the rate of skin ulceration caused by diarrhea would drop dramatically.