以品管圈手法降低腸造口周圍刺激性皮膚炎之發生率

Reduce the Incidence of Irritant Dermatitis around the Intestinal Stoma by Means of Quality Control Circle

本文旨在降低腸造口周圍刺激性皮膚炎發生率，本單位較多數病人診斷為直腸癌，術後常有腸造口留置，收集回診病人資料發現，腸造口周圍刺激性皮膚炎發生率較前一年同期回診病人高出1.46 倍，故引發改善動機。發生皮膚炎問題原因包括：一、制度：腸造口定位未列為常規作業、腸造口照護作業流程不一致；二、病人/ 主要照顧者：不清楚腸造口用物使用順序、不熟悉更換腸造口袋、不會剪裁腸造口底座及黏貼、腸造口排出液體有異味，害怕與他人互動、不知道腸造口皮膚發炎；三、醫護人員：衛教內容未介紹造口皮膚損傷、評估腸造口皮膚炎不一致、未做術前護理指導。解決辦法：一、制定腸造口照護之團隊共同照護流程；二、規劃造口周圍皮膚結構式組合照護；三、舉辦跨團隊的教育訓練及修訂團體衛教方式；四、拍攝衛教影片；五、術前安排腸造口衛教及研擬居家衛材QR cord；六、術前腸造口留置病友訪視。經改善後腸造口周圍刺激性皮膚炎發生率由60% 下降至32% 為專案結果。結論：以實證文獻為基礎擬定照護措施，藉由跨團隊溝通及醫療團隊支持，加上單位同仁全力配合，能有效降低腸造口周圍刺激性皮膚炎發生率。

"The objective of this study is to reduce the occurrence of peristomal irritant dermatitis. Most of the patients who sought treatment at the hospital unit that conducted this study were diagnosed with rectal cancer and received a permanent colostomy after sugery. According to patient data obtained through follow-up visits, the occurrence of peristomal irritant dermatitis was 1.46 times higher than those of patients that underwent follow-ups during the same period of the previous year. This motivated the authors to reduce the occurrence of peristomal irritant dermatitis resulting from several different factors including:(1)Healthcare systemrelated issues, such as a failure to include stoma siting in routine practice;(2) Patient/primary caregiver-related issues, such as inexperience over the procedures for the use of a colostomy bag,inexperience in changing the colostomy bag,inability to cut and adhere the base plate of the colostomy bag,a fear of interacting with others due to the odor of the stoma discharge, and peristomal dermatitis ignorance; (3) Healthcare worker-related issues, such as failure to cover peristomal skin damage when providing patient education, inconsistencies during stoma dermatitis assessments, and failure to provide pre-operative nursing care instructions.Several measures were proposed to overcome these issues: (1) Devise a shared nursing care procedure for the colostomy care team; (2) Plan structured care bundles for peristomal dermatitis; (3) Organizing multidisciplinary team training programs and revising group patient education procedures; (4) Produce patient education videos; (5) Provide pre-operative patient education and generating QR codes for in-home colostomy care; (6) Scheduling pre-operation visits to fellow patients with permanent colostomies. The main results of this study showed that following the implementation of these measures, the occurrence of peristomal irritant dermatitis dropped from 60% to 32%. Conclusion: Nursing care measures formulated based on evidence-based literature, alongside multidisciplinary team communication, medical team support, and cooperation from all healthcare workers, effectively reduced the occurrence of peristomal irritant dermatitis."