A Quality Improvement Program to Analyze the Causes of Notification Error and Increase Nurses Accuracy Rate of Pressure Injury Notification in Medical Group Wards

摘要

預防壓力性損傷的發生多年來在護理照護上一直備受關注，本文針對台灣南部一所區域教學醫院作研究，分析其壓力性損傷病患的盛行率、內科群組病房護理人員對壓力性損傷的知識及通報流程作評估。我們還分析了護理人員在壓力性損傷通報上錯誤的原因。經過互動式學習、案例分析、實際操作監測和學員回饋，我們評估了這項品質改進計劃對本院參與研究的208名護理人員的壓力性損傷通報正確率提升的效果，同時也對壓力性損傷病患的預後、護理人力和經濟效益作評估分析。經過本專案介入後，我們發現參與研究的208名護理人員通報正確率由65.3%提升到了88.4%、其維持效果甚至在計劃後的六個月內使通報正確率達93.3%。同時認知測試分數也由73.4分提升到84.2分、通報所需的時間從平均12.5分鐘下降到5.3分鐘、通報所需的護理人力共節省了約56.5小時，也相對應節省約新台幣9,438.8元的護理費用。同時，護理人員對薦椎傷口的照護無論在敷料覆蓋錯誤、敷料黏貼技巧錯誤、大小便染污方面均有大幅度的改善。此外，病患壓力性損傷傷口平均癒合率從計劃介入前的11.9%提升到介入後的25.0%。相信將來以同樣有實證基礎的品質改進計劃可同樣有效地改善其他醫療問題。
關鍵詞：護理人員、壓力性損傷通報錯誤、壓力性損傷通報正確率、品質改進計劃

Abstract

Preventing pressure injury has been a nursing concern for many years. This study included a survey of pressure injury prevalence, an assessment of the knowledge and notification process of nurses about pressure injury in medical group wards of a southern Taiwan regional teaching hospital. We also analyzed the causes of notification error of pressure injury. After an interactive learning session, case analysis, practice monitor and feedback, we evaluated the effect of this quality improvement program to increase nurses’ accuracy of pressure injury notification rate of our 208 nursing staffs included in this study, accompanying patient outcome, nursing manpower and economic benefit evaluation. After our intervention, we found nurses’ accuracy of notification rate improved from 65.3% to 88.4%, and even with 93.3% in the maintenance period about 6 months after our program. Besides, points of cognition test improved from 73.4 points to 84.2 points, every notification time decreased from 12.5 minutes to 5.3 minutes averagely. We saved nursing manpower about 56.5 hours and cost about NT$ 9,438.8 for the process of notification. Meanwhile, nursing staff had evident improvement of sacral pressure injury wound care, including decrease of wound dressing error, wound change dressing technique error, stool and urine wound pollution. In addition, we found that the average healing rate of pressure injury wound increased from 11.9% to 25.0%. It is believed that it could also be continuously reiterated for other medical issues that have associated evidence based practices for prevention.