提升關節置換手術後病人傷口自我照護正確性

背景：關節置換病人手術後兩周後傷口才會由醫師拆線，因此出院後病人仍需持續執行傷口照護，若返家未妥善照護，易增加感染風險。本專案經現況調查分析，確認專案問題為關節置換手術後病人傷口自我照護正確率低僅69%，分析原因為關節置換手術後病人表示年紀大記不住換藥步驟及用物、分不清楚傷口已經發紅或腫脹、指導過程因衛教時間趕著辦理出院導致中斷教學、護理人員執行傷口衛教指導完整率低，且傷口照護衛教於出院當日執行。
目的：提升關節置換手術後病人傷口自我照護正確性，進一步增加病人對傷口照護認知與技術正確性。
解決方案製作「傷口照護衛教指導交班卡」、「魔法敷料小卡」、「人工關節術後傷口照護小秘笈衛教影片」、「傷口評估紅綠燈警示圖卡」、提供客製化「傷口魔法護理包」提供護理師衛教病人時使用，也提供病人返家執行傷口照護工具。
結果：關節置換手術後病人傷口自我照護正確率由69%提升至98%。
結論：增加護理人員對關節置換手術後病人傷口照護衛教一致性，提醒病人傷口評估與照護步驟及瞭解傷口異常須立即返院，有效提升關節置換手術後病人傷口自我照護正確性。

Background & Problems: Joint replacement wound stitches are typically not removed until two weeks after the operation. Therefore, patients with joint replacement must be able to execute proper wound care after discharge from the hospital to reduce the risk of wound infection. Prior data from Chang Gung Memorial Hospital’s orthopedics ward indicate only 69% of joint-replacement patients are able to perform wound care properly at home. Potential causes for this noted by patients include age-related forgetfulness, being unable to discern redness or swelling in the wound, and language comprehension difficulties (i.e., Taiwanese vs. Mandarin). Poor rates of wound care may also be attributable to incomplete wound care education by nursing staff and wound care education being provided without adequate practice on the day of patient discharge.
Purpose: This project was implemented to improve the accuracy of wound self-care performed by patients after joint replacement surgery and to enhance their related knowledge and wound-care technical correctness.
Resolution: A wound care education checklist, wound care cue cards, wound care video clips, wound condition red flag cue cards, and customized wound care pack were proposed and implemented.
Results: The rate of accuracy of wound self-care performance increased from 69% pretest to 98% posttest, showing the intervention to have effectively improved post-discharge wound care quality.
Conclusions: To effectively improve the post-discharge accuracy of wound self-care in patients with joint replacement, the consistency of post-surgery wound care education given by nursing staff to patients should be improved, patients should be reminded of wound assessment and care steps, and patients should be aware that wound abnormalities require an immediate return to the hospital for follow-up treatment.