降低早產兒脫離保溫箱過程低體溫發生率

Reducing the Incidence of Hypothermia During the Weaning Process from Incubators in Preterm Infants

早產兒逐漸成熟後會脫離保溫箱轉至嬰兒床，作為其出院返家前哨，臨床發現早產兒於脫離保溫箱過程中容易發生低體溫，引發本改善動機。本文旨在降低早產兒脫離保溫箱過程低體溫發生率，以品管圈手法，找出需改善問題核心，包括：脫離保溫箱過程未標準化、沐浴時無法有效維持體溫穩定、護理師未能察覺執行哪些護理活動易使體溫下降、病室無法維持恆溫（如床位於出風口下方）。介入措施改善方法為建立脫離保溫箱之照護準則、製作圖示流程圖及提醒牌、執行在職教育、修訂沐浴規範、添購水溫計、創意口訣幫助記憶、訂定保暖準則、提升同仁對低體溫危害及察覺能力、宣導烤燈保暖使用、加裝導風罩，實施後早產兒脫離保溫箱過程低體溫發生率由27.8%下降至0%。本品質改善活動以實證文獻為依據並利用品質改善手法，各項改善對策相輔相成，單位同仁與醫療團隊整體合作配合，成功降低早產兒脫離保溫箱過程低體溫發生率。

As preterm infants mature, they transition from incubators to an open crib as a preliminary step before discharge. Clinically, it has been observed that preterm infants are prone to hypothermia during this transition, which motivates this improvement initiative. This study aimed to reduce the incidence of hypothermia in preterm infants during the weaning process from incubators using Quality Control Circle (QCC) methods. The main issues identified for improvement included the lack of standardization in the weaning process, the inability to maintain temperature stability during bathing effectively, nurses' unawareness of which nursing activities may cause temperature drops, and the failure to maintain constant room temperature (e.g., beds positioned under air vents). Intervention measures included establishing care guidelines for the weaning process, creating illustrated flowcharts and reminder signs, conducting in-service education, revising bathing protocols, purchasing water thermometers, developing mnemonic rhymes, setting warming guidelines, enhancing staff awareness to detect hypothermia hazards, promoting the use of heat lamps, and installing air deflectors. After implementing these measures, the incidence of hypothermia during the weaning process from incubators in preterm infants decreased from 27.8% to 0%. This project is based on empirical literatures and using Quality Control Circle (QCC) methods. Using theses improvement measures complement each other, and colleagues in the unit cooperated with the medical team as a whole to successfully reduce the incidence of hypothermia in premature infants during this transition from incubators.