降低腦中風病人鼻胃管留置比率

Decreasing the Number of Stroke Patients with Indwelling Nasogastric Tubes

目的：本專案活動目的在於提升腦中風吞嚥障礙者的吞嚥功能，避免出現誤吸或吸入性肺炎。吞嚥功能的提升讓病人早日由口進食，營養攝取足夠及體能恢復，有助於提昇日常活動參與度及生活品質。在健保支出概算，鼻胃管移除成功每人每年至少可減少29,562元的費用。方法：單位成立跨專業改善小組，圈員多次圈會討論，運用現況分析、文獻查證、查檢法與三現法等品管手法，分析出真因提出對策並實施。擬定對策群組為：一、吞嚥治療法的調整；二、改良口腔動作練習單張及提供衛教影片（提供QRcode掃描）；三、照顧者端的食物調配法與餵食方法；四、電子病歷系統提供吞嚥注意事項；五、增設「鼻胃管移除吞嚥功能檢核表」及「吞嚥治療流程圖」。結果：對策執行至104年12月25日，鼻胃管留置比率由改善前64.5%降至22.2%。目標達成率為152.2%、進步率為65.9%。結論：本研究發現對策實施後可降低腦中風病人鼻胃管留置比率。治療法的調整、照顧者與其他專業人員的投入與配合可使吞嚥治療效率提高，形成完整有效的治療計畫。

Purposes The aim of this project was to improve the swallowing function of stroke patients with dysphagia to avoid aspiration or aspiration pneumonia. Improving swallowing function enables patients to feed freely, obtain sufficient nutrition, recover physical functions, and participate in daily activities, which improves their quality of life. From the perspective of medical costs, nasogastric tube removal can save at least 29,562 NTD in costs per year. Methods A cross-disciplinary improvement group was created. Members of the group performed roundtable discussions, current situation analyses, literature reviews, and inspections. Three principles of the scene reality and other quality control measures were used to analyze the root causes of the problems. Implementation of the following countermeasures were proposed: 1. dysphagia treatment modification; 2. provision of information leaflets on improving oral-motor exercises and health education videos (providing QR code for scan); 3. caregiver education on food preparation and feeding methods; 4. electronic patient record system that provides swallowing precautions; and 5. use of a nasogastric tube removal and swallowing function checklist and dysphagia treatment flow chart. Results These countermeasures have been implemented since December 25, 2016, and the percentage of patients with indwelling nasogastric tube decreased from 64.5% to 22.2%. The target achievement and improvement rates were 152.2% and 65.9%, respectively. Conclusions The implementation of countermeasures decreased the percentage of stroke patients with indwelling nasogastric tubes. Modifying the treatments and involving the caregivers and other professionals can increase the effectiveness of the dysphagia treatment and help in the creation of complete and effective treatment plans.