降低某加護單位病患發生腹瀉性皮膚炎之專案

Diarrhea is a common intensive care problem which can lead to skin dermatitis in patients if not prevented. If it occurs and is not handled appropriately, wound healing will take longer and require a greater number of nursing hours. We design a study to gain more insight into the problem and reduce the incidence of diarrheal dermatitis in one Intensive Care Unit. Between January and May 2007, there was an average of four incidents of diarrheal dermatitis each month. The reasons leading to the problem were (1) the diapers had been replaced soon enough to allow ventilation of patient's skin, (2) wet wipes were almost always used, (3) warm water was not used for cleaning patient's bottom, (4) diarrhea was caused by certain medications, including Lactulose, Kayxalate and other emollient laxatives, and (5) feeding enteral feel formula was prepared a inappropriate strengths.. After a review of the literature and discussion by project team, we established diarrheal dermatitis prevention criterion, used a bottom-protecting towel as a wiping item and establishing a procedure to handle diarrhea. With these implementations, the average number of diarrheal dermatitis incident dropped from 4 to 1. This showed an excellent result achieved by the project and also more agreements reached between medical and nursing teams on preventing diarrheal dermatitis, so the quality of nursing care of an intensive care unit was then raised.
腹瀉是加護單位中常見的問題，若皮膚頻繁接觸糞便易形成皮膚炎，此問題若無完善照護，會延遲皮膚傷口的癒合而增加護理時數，故本專案目的為降低病患發生腹瀉性皮膚炎件數。本單位自2007年1月至5月統計腹瀉性皮膚炎平均每月件數約為4件，經分析問題主要與1、未及時更換尿布維持通風；2、擦拭物品單一選擇以濕紙巾為主；3、未使用溫水清洗臀部；4、用藥（Lactulose, Kayxalate及軟便劑）導致腹瀉；5、管灌配方濃度不適合有關。經由文獻查證與專案小組討論後，執行腹瀉性皮膚炎防範標準、擦拭用物護臀巾運用、及建立腹瀉處理流程，經對策實施後，腹瀉性皮膚炎件數由每月4件降至1件，此專案達良好成效，且增進醫護團隊對於腹瀉性皮膚炎防範的共識，提升加護單位的照護品質。