提升加護病房呼吸器依賴病人家屬之氣切認知率

Improving the Awareness Rate of Tracheostomy in Family of VentilatorDependent Patients in the Intensive Care Unit

目的：呼吸器依賴病人由氣管插管換成氣切造口是臨床照護常規，但本單位醫師建議呼吸器依賴病人做氣切時，家屬總反應氣切會有嚴重的併發症，而以拒絕或再考慮來回應，呼吸器依賴病人對單位整體滿意度僅75%。本專案目的在提升呼吸器依賴病人家屬之氣切認知率。經問題分析原因為：氣切說明流程不完整、家屬氣切認知率低、氣切衛教未完整。方法：修訂氣切說明流程、規劃氣切種子方案與家庭會議制度、製作QR code連線衛教影片及人工氣道輔具模組。結果：專案推動後呼吸器依賴病人家屬之氣切認知率由43.8%提升至97.2%，家屬考慮氣切的時間由4.5天縮短至2.1天。結論：本專案不但提升呼吸器依賴病人家屬之氣切認知率，也提升護理人員的氣切衛教能力，期能藉此專案成效提供其它加護病房之參考。（澄清醫護管理雜誌2019；15（3）：64-73） Purposes Converting from an endotracheal tube to tracheostomy is a routine clinical practice for ventilator-dependent patients. However, when physicians in our unit recommend tracheostomy for ventilator-dependent patients, patients' family reject or reconsider the procedure because they feel that it comes with a risk of severe complications. The overall satisfaction of ventilator-dependent patients in our unit is only 75%. The aim of this project was to increase the awareness of family of ventilator-dependent patients on tracheostomy. After analysis, we found several problems, which are as follows: incomplete explanation process for tracheostomy, low awareness of family, and incomplete health education on tracheostomy. Methods We have revised the explanation process for tracheostomy, formulated tracheostomy protocols and a family meeting system, and created QR codes that are linked to health education videos and artificial airway tool modules. Results After the implementation of the program, the awareness of family of ventilatordependent patients increased from 43.8% to 97.2% and the time taken for family to consider tracheostomy decreased from 4.5 days to 2.1 days. Conclusions This project not only improved the tracheostomy awareness of family of ventilatordependent patients but also enhanced the ability of nurses to implement health education on tracheostomy. We hope that the effectiveness of this project can provide a reference for other intensive care units. (Cheng Ching Medical Journal 2019; 15(3): 64-73)