降低外科加護病房非計劃性氣管内管拔管發生率

Decreasing unplanned extubations rate in the surgical intensive care unit

維持呼吸道的通暢是人類生存的基本條件。在加護病房中氣管內插管留置的病患佔大多數，一旦滑脫，不但會危及病患安全也會增加醫療資源的耗用及照護的困難度。統計本單位自民國90年8月至91年7月間氣管內管留置人數爲3469人日，非計劃性拔管人次爲25人，拔管發生率爲0.72％。分析其原因有病患插管不舒適而躁動不合作、病患知識不足、約束方法未制定及落實等因素所致。爲有效提高護理品質，針對缺失制定鎭靜止痛流程、相關作業流程標準化、家屬照顧須知及護理原則，並加強與病患及家屬的溝通。經改善後氣管內管平均滑脫率已明顯下降爲0.22％。經由此次專案的進行在改善過程中，能獲得相當的肯定，充分展現團體合作的精神，並提升病患及家屬對醫療照護的滿意度。

Maintaining airway potency is essential for life support. Most patients admitted to intensive care unit (ICU) are intubated with endotracheal tube (ETT). Dislocation of ETTs not only endangers the patients' life but also consumes additional medical resources and increases the difficulty in nursing care. From August 2001 to July 2002, ETTs were placed 3469 patient-days in our unit. And dislocation of ETTs occurred 25 times; the dislocation rate of ETT was 0.72%. Dislocation of ETTs may result from several factors, e.g. the presence of foreign body in nasopharynx, patients experienced uncomfortable and were irritable; patients were not well-educated about the ETTs; SOP for patient constrain was not well established and proper practice, etc. In order to improve the quality of nursing care and patients' comfortable, several practices were employed to overcome the defaults. These included: establishing the protocol for patient sedation and pain control; standardizing the practice algorithm; providing the family members information regarding to the patients' care and principle of care; reinforcing the communication with patients themselves and their family members. After applying the above protocols, dislocation rate of ETTs has been reduced to 0.22%. Through the execution of this project, we were able to obtain self-affirmation in problem solving, to proclaim the spirit of our teamwork, and to increase the satisfaction and confidence of patients and their family members to our daily care.