以品管圈－－課題達成型手法提升外科重症病人熱量及蛋白質達成率

The Application of Quality Control Circle to Improve Nutritional Status of Patients in Surgical Intensive Care Units

營養是重症醫療照護的一環，許多研究表明熱量缺乏會增加院內感染風險、延長呼吸器使用天數、住院天數等，但重症病人病況危急、熱量困難計算以及短時間不容易看到營養不良所致危害，因此容易忽略或延遲營養治療。2020年調查本院外科加護病房病人熱量達文獻建議量為67.2%，而僅20.2%蛋白質達文獻建議量，因重症營養治療賴於跨團隊合作，故成立品管圈欲大幅改善外科加護病房病人熱量、蛋白質適當達成率，經QC story判定-使用課題達成型為改善手法來進行品質改善，在最適策追究，選出三項最適策具體化方案:「除舊佈新、知識升級」、「資訊即時、智慧預警、無痛導入」及「標準一致、同步向前」進行品質改善；在效果確認「第7天熱量適當」由67.2%提升至100%，而「蛋白質適當」從20.2%提升至95%，兩組在改善前、後皆具有統計上差異，以短期效果而言相當顯著。

Nutrition is an integral part of critical care practice. Several studies have shown that calorie deficiency in patients in intensive care units increases the risk of nosocomial infection and prolongs ventilator use and hospitalization. However, nutritional support of these patients is sometimes ignored or delayed for reasons such as patients' critical condition and the lack of precise calorie recording. We examined the medical report of the patients who were admitted in the surgical intensive care unit of the National Cheng Kung University Hospital in 2020. According to the recommendations of the European Society for Clinical Nutrition and Metabolism 2019 guidelines, calorie intake was adequate for only 67.2%, and the suggested daily protein intake was achieved in only 20.2%. Because nutrition therapy in critical illness relies on interprofessional collaboration, we invited experts from each field to promote the following task-oriented quality:“updated nutrition, knowledge in critical care”,“real-time monitoring and warning”, and“standardized protocols”. After intervention in our study, the proportion more than 70% of the estimated adequate daily calorie intake rose from 67.2% to 100%, and patients receiving at least 1.3 g/kg/day of protein rose from 20.2% to 95%. The differences were statistically significant. These results support the use of our strategy for achieving better nutrition in critical ill patients.