降低內科病房壓傷發生率之改善專案

A Quality Improvement Project to Reduce the Incidence of Pressure Injuries in a Medical Ward

目的
針對內科病房壓傷發生率0.57％進行分析，探討醫療裝置與非醫療裝置壓傷的主要來源，希望提升護理人員與照顧服務員對壓傷之早期辨識與預防能力，優化壓傷高風險病人之照護流程，強化團隊合作，以提升病人安全與整體照護品質。
方法
經由「壓傷發生登錄查檢表」與「相關標準作業流程」，分析現況，主要導因為：一、人員方面：護理人員壓傷評估不確實且認知不足、呼吸器面罩尺寸評估不一致；照顧服務員未按時翻身且擺位不正確。二、醫療器材方面：市售減壓墊不合病人臉型。三、流程方面：系統未有提醒評估機制。2022年7月至12月推動改善專案，包括舉辦壓傷教育訓練、應用呼吸器面罩測量板、執行定時翻身及正確擺位技巧、呼吸器面罩減壓墊臨床應用、執行壓傷評估時機。
結果
在專案實施後，「內科病房壓傷發生率」由0.57％下降至0.16％，「護理人員預防壓傷照護認知及行為正確率」由73％提升至96％，「照顧服務員預防壓傷照護技能正確率」由72％提升至93％。
結論
藉由本專案介入後，降低內科病房壓傷發生率，有效提升護理人員及照顧服務員預防壓傷的認知及技能，期能藉此專案成效提高醫療照護品質。

Purposes
To reduce the 0.57% incidence of pressure injuries in an internal medicine ward by identifying key causes of device-related and non-device-related injuries, thereby enhancing the ability of nurses and nursing aides to recognize and prevent injuries early, optimizing care for high-risk patients, and strengthening team collaboration to improve patient safety and quality of care.
Methods
Using the Pressure Injury Incident Checklist and standard operating procedures, several key contributing factors were identified, including inaccurate nursing assessments, inconsistent selection of respiratory masks, inappropriate patient turning and positioning, poorly fitted pressure relief cushions, and an absence of system alerts. Between July and December 2022, targeted interventions were implemented, including staff training, the introduction of mask measurement tools, scheduled repositioning with appropriate body positioning techniques, the use of pressure relief cushions, and an audit system to monitor the accuracy of assessment and care practices.
Results
Following implementation, the incidence of pressure injuries decreased from 0.57% to 0.16%. Nurse knowledge and accuracy in preventive practices improved from 73% to 96%, and the accuracy of nursing aide skills increased from 72% to 93%.
Conclusions
The project successfully reduced the incidence of pressure injuries in an internal medicine ward and enhanced staff knowledge and preventive skills, leading to improved patient safety and overall quality of care.