降低血液腫瘤科病人失禁性皮膚炎發生率

Reducing Incontinence-Associated Dermatitis in Hematology-Oncology Patients

單位血腫病人2023年壓力性損傷（pressure injury，PI）發生率達0.41%，26.4%發生於臀部及尾骶骨，高於2022年之14.5%，與失禁性皮膚炎（incontinence-associated dermatitis，IAD）相關者佔61.5%，故查核單位IAD發生率高達12%，較癌症病人IAD為6.7%高出許多，如此將增加免疫低下病人感染風險，期望藉此專案降低單位IAD發生率。經分析主要原因為護理師缺乏教育訓練、照顧者因照護步驟多，不易記得、無查核IAD照護品質機制及標準作業規範。藉由制定照護標準流程與查核機制、宣導海報、觀察紀錄表與高風險警示卡，舉辦在職教育提升護理師認知，加強IAD風險評估及指導。IAD發生率由12%下降至3.1%，照顧者結構式照護（bundle care）正確執行率由31%提升至90%，達專案改善目標。建議系統增加IAD風險評估項目及警示、建立互動式學習資源、床頭資訊面板，主動提醒翻身換尿布時機。

In 2023, the incidence rate of pressure injuries (PI) in the hematology unit reached 0.41%, with 26.4% occurring on the buttocks and sacrococcygeal area—an increase from 14.5% in 2022. Among these cases, 61.5% were associated with incontinence-associated dermatitis (IAD). A subsequent audit revealed that the unit’s IAD incidence rate was as high as 12%, significantly exceeding the 6.7% rate observed among oncology patients. This elevated rate increases the risk of infection in immunocompromised patients. Therefore, this quality improvement project aimed to reduce the incidence of IAD within the unit. Root cause analysis identified several contributing factors: insufficient education and training among nursing staff, caregivers struggling to remember complex care procedures, and the absence of a standardized protocol and quality monitoring system for IAD care. In response, a standardized care process and audit mechanism were developed, along with the implementation of educational posters, observation checklists, and high-risk patient alert cards. In-service education sessions were conducted to enhance nurses’knowledge, strengthen IAD risk assessment, and reinforce appropriate guidance.
As a result, the incidence of IAD decreased from 12% to 3.1%, and the accurate implementation rate of bundle care among caregivers improved from 31% to 90%, meeting the objectives of the project. It is recommended that the hospital information system incorporate IAD risk assessment indicators and alerts, develop interactive learning resources, and utilize bedside information panels to proactively remind staff of repositioning and diaper-changing schedules.