呼吸器相關肺炎組合式照護推行細則的探討

Ventilator-Associated Pneumonia Bundle Implementation: a Literature Review

呼吸器相關肺炎的發生顯著影響病人安全的議題，包含死亡率、住院天數和醫療費用，因此自從美國醫療品質策進協會於2004年提出組合式照護的概念，以及針對呼吸器相關肺炎組合式照護項目提出建議，包括：床頭抬高30～45度、每天中止鎮靜劑及進行拔管評估、預防消化性潰瘍及預防深部靜脈栓塞後，呼吸器相關肺炎組合式照護陸續被應用於臨床，並達到提升遵從性、降低呼吸器使用、加護單位住院天數及肺炎感染的發生。本篇藉由文獻的回顧，以瞭解在呼吸器相關肺炎組合式照護推廣的過程，包括施行單位的選定、組成工作小組、組合式照護的項目、遵從的定義及評估方式、遵從率目標值及成果指標的設定等細節，以作為政策推行之參考。

Ventilator-associated pneumonia (VAP) is a patient safety issue that pertains to mortality rates, ventilator days, intensive care unit lengths of stay, and costs. Accordingly, the Institute for Healthcare Improvement advocated the use of bundles, saving 100,000 lives in 2004. They recommended that the elements of VAP bundles should encompass head elevation, daily assessment of sedation cessation, daily assessment of ventilator weaning, and prophylaxis of peptic ulcers and deep vein thromboses. Thereafter, VAP bundles were implemented in clinical care and demonstrated significant effects on the prevention of VAP. This article reviews the details concerning the implementation of VAP bundles, including making decisions regarding units where VAP bundles are used, team workers involved, bundle elements, compliance definitions, monitoring methods, goals, and outcome indicators.