提升氣管內管留置病人口腔照護完整率

Promoting the Completion Rate of Oral Hygiene for Patients with Endotracheal Tubes

目的：氣管內管置入會影響口腔黏膜健康，良好的口腔照護可促進病人舒適及減少口腔疾病。因口腔護理師稽核單位留置氣管內管病人口腔衛生，發現口腔清潔後仍有痰塊、口腔異味、嘴唇乾燥未適當防護及口腔黏膜疾病等不良問題，故本專案旨在提升加護病房護理人員口腔照護認知及口腔照護完整率。方法：專案改善過程中藉由擬訂相關教育訓練、制定「口腔照護標準」、製作宣導海報及定期臨床稽核，且藉由「新式氣管內管固定法」改善氣管內管固定耗時問題，將時間真正用於口腔清潔上。結果：口腔照護認知得分80分以上由0 ％ 提升至86％；護理人員執行氣管內管留置病人口腔照護完整率由0％提升至63％。結論：本專案重視氣管內管置入病人因口腔衛生所衍生的口腔健康問題，藉由教育人員提升對口腔照護認知，改善耗時的氣管內管固定方式，將時間用於提供更完整的口腔照護，並將修訂完整「口腔照護規範」提案至護理部及推廣至其他加護單位，藉由完整及正確的口腔照護使更多病人得到更好的照護品質。

Purposes: Endotracheal intubation affects the oral mucosa. Sound oral care promotes comfort and decreases the chances of oral diseases. Oral care practitioners, while examining the oral hygiene of patients with endotracheal intubation, found that even after oral cleansing, those patients still suffered from problems such as sputum, oral odor, inappropriate protection against dried lips, and oral mucosa diseases. Therefore, the current project aimed to promote intensive care unit (ICU) nursing staff’s oral care knowledge and the completion rate of oral care. Methods: We drafted relevant educational training, formulated “Oral care standards,” designed promotional posters, performed regular clinical examinations, and developed a “New endotracheal intubation fixation,”which shortened the time for endotracheal intubation fixation, allowing more time for oral cleansing. Results: Oral care knowledge (higher than 80 points) increased from 0% to 86%, and the oral care completion rate practiced by nursing staff improved from 0% to 63%of patients with endotracheal intubation. Conclusions: The project focused on oral health as a result of oral hygiene among patients with endotracheal intubation. With enhanced oral care knowledge among educators, timesaving endotracheal intubation fixation that frees time for more complete oral care, and the promotion of “Oral care standards” to the nursing department as well as other ICU units, patients will receive better quality care as a result of complete and accurate oral care.