54 Lowering the Incidence of Pressure Sores 表一神經外科手術患者壓瘡基本資料 N = 18 n % 性別年齡術中體溫 > Braden

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1 53 降低神經外科手術患者壓瘡發生率之方案張昭惠陳惠玲 * 陳香祺壓瘡一直是醫療院所普遍存在的問題之一, 國內外文獻均指出, 每年需支付相當大的醫療費用於治療壓瘡患者身上, 而手術引起的壓瘡佔 12 66%, 其中神經外科患者因手術時間長, 更易形成壓瘡本專案小組統計手術室 2004 年 5 月至 8 月各科壓瘡發生比率, 其中以神經外科最高為 9.5%, 經分析發現 : 同仁對壓瘡的認知及預防方法不一, 故針對問題提出改善對策, 制定壓瘡防護標準增設壓瘡危險因子評估建立護理品質追蹤改善制度安排在職教育設計棉捲做特殊防護並施行個別輔導後, 神經外科手術患者壓瘡發生率由 9.5% 降至 7%, 不僅達到良好的成效, 並增加手術醫療團隊對預防壓瘡之共識, 進而提升手術照護品質手術壓瘡預防前 12 66% Beckrich & Aronovitch, 1999 Scott Leaper Clark Kelly Young, Evans, & Davis, ,000 70, Waterlow % , = 100 言手術過程壓瘡發生原因分析 *

2 54 Lowering the Incidence of Pressure Sores 表一神經外科手術患者壓瘡基本資料 N = 18 n % 性別年齡術中體溫 > Braden Scale 值 < 急診手術使用溫毯眼皮黏貼紙膠使用懸吊帶慢性疾病營養狀況 4g/dl 6 33 < 4g/dl g/dl < 13g/dl < mmHg 6 33 < 60mmHg BMI < 18.5 或 > 術前皮膚乾燥薄水腫手術時間超過 4 小時手術臥位 BMI = Body Mass Index 表二神經外科手術患者壓瘡發生部位之比率 N = 35 圖一神經外科平均手術時間 n %

3 55 圖二壓瘡發生率高之特性要因圖表三神經外科手術患者壓瘡發生原因比率 N = 70 n % 手術與壓瘡形成之相關性 Bergstrom, Braden, Kemp, Champagne, & Ruby, g/dl 38 Albumin 4.0g/dl Lewicki, Mion, Splane, Samstag, & Secic, 1997 MeEwen, Hoshowsky & Schramm, 1994 Aronovitch Sanada 1997 Armstrong & Bortz, mmHg

4 56 Lowering the Incidence of Pressure Sores 醫護人員對壓瘡預防之重要性 Hoshowsky Schramm 解決辦法與決策 9.5% 8.1% 一計劃期 (2004 年 9 月 1 日 ~2004 年 10 月 31 日 ) ㈠ = = 8.1 ㈡ Braden Scale 18 BMI < 18.5 > OP site ㈢㈣二執行期 (2004 年 11 月 1 日 ~2004 年 12 月 31 日 ) ㈠

5 57 表四神經外科手術患者壓瘡發生部位專案實施前後比較 n = n = > 4 > g/dl < 13g/dl Braden Scale < 18 ㈡㈢㈣三評值期(2005 年 1 月 1 日 ~2005 年 4 月 30 日 ) 結果評值 = 9.5% 7% 9.5% = 26.3% = 7% 9.5% 8.1% 9.5% 100% = 179% 結論 9.5 7

6 58 Lowering the Incidence of Pressure Sores 阻力限制及建議參考文獻 Armstrong, D., & Bortz, P. (2001). An integrated review of pressure relief in surgical patients. AORN Journal, 73(3), Aronovitch, S. (1999). Intraoperatively acquired pressure ulcer prevalence: A national study. Wound Ostomy Continence Nurses, 26(3), Beckrich, K., & Aronovitch, S. A. (1999). Hospital-acquired pressure ulcer: A comparison of coasts in medical and surgical patients. Nursing Ecomomics, 17(5), Bergstrom, N., Braden, B. J., Kemp, M., Champagne, M., & Ruby, E. (1998). Predicting pressure ulcer risk: A multisite study of the predicting validity of the Braden Scale. Nursing Research, 47(5), Hoshowsky, V., & Schramm, C. (1994). Intraoperative pressure sore prevention: An analysis of bedding materials. Research Nurses Health, 17(5), Lewicki, L., Mion, L., Splane, K., Samstag, D., & Secic, M. (1997). Patient risk factors for pressure ulcers during car-

7 59 diac surgery. AORN Journal, 65(5), McEwen, D. R. (1996). Intraoperative positing of surgical patient. AORN Journal, 63(6), Sanada, H. (1997). The role of skin blood flow on pressure ulcer development during surgery. Advance Skin Wound Care, 10(6), Scott, E. M., Leaper, D. J., Clark, M., & Kelly, P. J. (2001). Effects of warming therapy on pressure ulcers in surgical patients. AORN Journal, 73(5), Waterlow, J. (1998). Prevention is cheaper than cure. Nursing Times, 84(25), Young, Z. F., Evans, A., & Davis, J. (2003). Nosocomial pressure ulcer prevention. Journal of Nursing Administration, 33(7/8), 附件一手術室患者壓瘡事件發生報告表 Supine Prone Lithotomy Jack Knife R t Lateral L t Lateral Sitting Trendelenburg (Action Pad) ± 10% ± 10% Endo EKG < 4hrs Tourniquet mmhg Kg cm HbHct albumin mg/dl(<3.5 mg/dl) DM PAOD H/T 6. 60mmHg

8 60 Lowering the Incidence of Pressure Sores Program for Lowering the Incidence of Pressure Sores in Neurosurgical Patients Chau-Hui Chang Hui-Ling Chen * Hsiang-Chi Chen Abstract: Pressure sores are one of the well known problems that occur in hospitals. As the literature on the subject indicates, a lot of money is expended in managing this problem every year, and 12 66% of pressure sores are caused during surgery. Patients who undergo neurosurgical procedures are susceptible to pressure sores because of lengthy operations. We collected data on patients with pressure sores who underwent surgery between May 2004 and August 2004, and found that the incidence of pressure sore in neurosurgical patients was 9.5, which was the highest among all surgical patients. This project was developed to solve the problem of pressure sores by setting up standard preventive procedures, a nursing follow up system and continuing education courses, and utilizing cotton rolls to pad sites of pressure sores. The incidence of pressure sore in neurosurgical patients was reduced from 9.5% to 7% after the improvement project was carried out. The more concerned nurses are about pressure sores, the better the quality of operative nursing care. Key Words: operation, pressure sore, prevention. RN, BSN, Department of Nursing, Kaohsiung Veterans General Hospital; *RN, BSL. Received: August 30, 2006 Revised: May 10, 2007 Accepted: September 13, 2007 Address correspondence to: Hsiang-Chi Chen, No. 386, Da-Chung 1st. Rd., Kaohsiung 81362, Taiwan, ROC. Tel: 886(7) ext. 706; apple880605@yahoo.com.tw

102 Intraoperative Positioning Injuries 一 -1 仰臥一 -2 半坐臥式一 -3 截石術臥位一 -4 俯臥位一 -5 側臥位 McGlinch et al., Armstrong & Bortz, 2001; Hoshowsky, 199

102 Intraoperative Positioning Injuries 一 -1 仰臥一 -2 半坐臥式一 -3 截石術臥位一 -4 俯臥位一 -5 側臥位 McGlinch et al., Armstrong & Bortz, 2001; Hoshowsky, 199 101 手術中擺位傷害之護理 1 聖母醫護管理專科學校護理科講師施佳玟 1 羅惠敏 2* 慈濟大學醫學研究所博士候選人 2 聖母醫護管理專科學校護理科講師暨摘要 : 手術中安全合適的擺位較少被探討, 合適的擺位可以讓手術範圍獲得最佳的暴露讓麻醉人員最近的距離來監測呼吸道的通氣情形維護病患生理的安全, 並且可以避免不必要的暴露以維護病患尊嚴手術中的擺位不良會讓病患受到傷害, 短時間的傷害可能引發神經損傷,

54 Lowering the Incidence of Pressure Sores 表一神經外科手術患者壓瘡基本資料 N = 18 n % 性別 年齡 術中體溫 > Braden

54 Lowering the Incidence of Pressure Sores 表一神經外科手術患者壓瘡基本資料 N = 18 n % 性別年齡術中體溫 > Braden