98 預防手術後壓瘡照護流程之發展 1 2 3 4 * 1 2 3 4 摘要 : 關鍵詞 : 前言 2010 2013 2,000-3,000 7,000-80,000 2013 40% 2010 12-66% 25% Walton-Geer, 2009 2011 Taiwan Clinical Performance Indicator, TCPI National Pressure Ulcer Advisory Panel, NPUAP 2014 Association of Operating Room Nurses, AORN 2013 104 4 14 doi:10.6224/jn.62.6.98 * 11219 365 02 28227101 2700 E-mail shufang@ntunhs.edu.tw 引用格式 201562 6 98 104 [Huang, Y. L., Lin, H. L., Wang, F., & Wu, S. F. V. (2015). The development of a care protocol for postoperative pressure sore prevention. The Journal of Nursing, 62(6), 98 104.] doi:10.6224/jn.62.6.98
99 手術後壓瘡之評估 predisposing factor facilitating factor Bluestein & Javaheri, 2008 2013 65 45% Walton-Geer, 2009 albumin 3.5 g/dl75% body mass index, BMI 18.5 kg/m 2 12.73 g/dl Serpa & Santos, 2014 2010 2011 NPUAP, 2014 Ad edeji, Oragui, Khan, & Maruthainar, 2010; Low, Vasanwala, & Tay, 2014 12-32 mmhg 70 mmhg NPUAP, 2014 Beckett, 20104 4 7 13.2% Beckett, 2010 Low et al., 2014 2011 AORN, 2013 2011 NPUAP, 2014 > 41 1 10% AORN, 2013 Adedeji et al., 2010 48 2013 Munro, 2010 Braden 16 Serpa & Santos, 2014 Munro American Society of Anesthesiologists pre-anesthesia evaluation score, ASA score 護理雜誌 62 卷 6 期 中華民國 104 年 12 月
100 Munro Munro, 2010 Braden Munro 10.82 KR-20.86 7 7 7 手術後壓瘡之預防 95% 2013 一 手術後壓瘡相關危險因素之預防措施 2011 Beckett, 2010 Iranmanesh, Rafiei, & Ameri, 2011 2011 30 Low et al., 2014 AORN, 2013 手術後壓瘡風險評估量表 : : : : : () 65 ( :) 手術後壓瘡相關危險因素之預防措施 1. 2. 3. 4. 5. 6. 7. 8. 30 30 9. 10. 7 特殊手術臥位之保護措施 1. < 90 2. < 90 3. 4. 圖一預防手術後壓瘡照護流程圖
101 AORN, 2013 2014 二 特殊手術臥位之保護措施 Beckett, 2010 2011 AORN, 2013; NPUAP, 2014; Walton-Geer, 2009 ㈠ 90 ㈡ < 90 ㈢ ㈣ / 圖二仰臥擺位重點 圖三俯臥擺位重點 圖四側臥擺位重點 圖五截石臥位擺位重點 護理雜誌 62 卷 6 期 中華民國 104 年 12 月
102 預防手術後壓瘡照護流程之臨床應用 60 7 55 20% 結論 參考文獻 2014 http:// tcpi.tjcha.org.tw/tcpi/ [Taiwan Clinical Performance Indicator. (2014). Comprehensive care indicators. Retrieved form http://tcpi.tjcha.org.tw/tcpi/] 2011 58 5 101 106 [Shih, C. W., & Lo, H. M. (2011). Nursing care for intraoperative positioning in juries. The Journal of Nursing, 58(5), 101 106.] doi:10.6224/ JN.58.5.101 2014 http://www.actionpad.tw/html/front/bin/ptlist.phtml?category=356835 [Strengthen Medical Instrument Co., Ltd. (2014). Surgery patients at risk of pressure sores. Retrieved form http://www.actionpad.tw/html/front/bin/ ptlist.phtml?category=356835] 2013 60 4 65 75 [Tsao, W. Y., Lo, S. F., Harmod, T., & Lee, R. P. (2013). A comparison of the efficacy of different wound dressing management techniques in preventing pressure ulcers. The Journal of Nursing, 60(4), 65 75.] doi:10.6224/jn.60.4.65 2013 9 2 40 47 [Chen, N. W., Chang, T. H., & Chang, S. H. (2013). A systematic review of nurses preventive behavior with regard to pressure ulcers. Cheng Ching Medical Journal, 9(2), 40 47.] 2010 37 9 22 28 [Tseng, Y. R., & Yan, J. S. (2010). Treatment and prevention of pressure sores. Medicine Today, 37(9), 22 28.] Adedeji, R., Oragui, E., Khan, W., & Maruthainar, N. (2010). The importance of correct patient positioning in theatres and implications of mal-positioning. Journal of Preoperative Practice, 20(4), 143 147. Association of Operating Room Nurses. (2013). Recommended practices for positioning the patient in the perioperative practice setting. Retrieved from http://www.mediteksurgi cal.ca/wp-content/uploads/2013/02/aorn-recommended Practices-for-Positioning-the-Patient-in-the-Perioperative Practice-Setting.pdf Beckett, A. E. (2010). Are we doing enough to prevent patient injury caused by positioning for surgery? Journal of Preoperative Practice, 20(1), 26 29. Bluestein, D., & Javaheri, A. (2008). Pressure ulcers: Preven-
103 tion, evaluation, and management. American Family Physician, 78(10), 1186 1194. Iranmanesh, S., Rafiei, H., & Ameri, G. F. (2011). Critical care nurses knowledge about pressure ulcer in southeast of Iran. International Wound Journal, 8(5), 459 464. doi:10.1111/j.1742-481x.2011.00817.x Low, L. L., Vasanwala, F. F., & Tay, A. C. (2014). Pressure ulcer risk assessment and prevention for the family physician. Proceeding of Singapore Healthcare, 23(2), 142 148. Munro, C. A. (2010). The development of a pressure ulcer risk-assessment scale for perioperative patients. AORN Journal, 92(3), 272 287. doi:10.1016/j.aorn.2009.09.035 National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. (2014). Prevention and treatment of pressure ulcers: Quick reference guide. Retrieved from http://www.npuap.org/wp-content/uploads/2014/08/updated-10-16- 14-Quick-Reference-Guide-DIGITAL-NPUAP-EPUAP- PPPIA-16Oct2014.pdf Serpa, L. F., & Santos, V. L. C. G. (2014). Validity of the braden nutrition subscale in predicting pressure ulcer development. Journal of Wound, Ostomy and Continence Nursing, 41(5), 436 443. doi:10.1097/won.0000000000000059 Walton-Geer, P. S. (2009). Prevention of pressure ulcers in the surgical patient. AORN Journal, 89(3), 538 552. doi:10.1016/j.aorn.2008.12.022 護理雜誌 62 卷 6 期 中華民國 104 年 12 月
104 The Development of a Care Protocol for Postoperative Pressure Sore Prevention Yu-Ling Huang 1 Hui-Ling Lin 2 Fang Wang 3 Shu-Fang Vivienne Wu 4 * 1 MSN, RN, Department of Nursing, National Taiwan University Hospital; 2 MS, RN, Supervisor, Department of Nursing, National Taiwan University Hospital; 3 BSN, RN, Head Nurse, Department of Nursing, National Taiwan University Hospital; 4 PhD, RN, Professor, Department of Nursing, National Taipei University of Nursing and Health Sciences. ABSTRACT: Pressure sores are a common complication caused by long periods of bed rest following major surgery. These sores may increase patient postoperative pain, increase the risk of infections, lengthen the period of hospitalization, and increase the duration and costs of nursing care. Therefore, maintaining the skin integrity of surgical patients is an important responsibility for operating room nurses and an indicator of nursing care quality. While pressure-sore risk assessment tools and interoperative strategies are available and used in foreign countries, there has been little related research conducted in Taiwan. After examining the relevant literature and considering the current postoperative pressure sore situation in Taiwan, the author developed a postoperative pressure sore care protocol as a reference for clinical staff. Protocol procedures include major breakthrough developments in areas such as post-survey risk assessment for pressure ulcers, pressure ulcer prevention strategies that take surgery-related risk factors into consideration, extra care and protection measures for surgical supine patients, and post-pressure sores. The developed postoperative pressure sore protocol may be incorporated into surgical care procedures during the post-surgical care period in order to effectively prevent the occurrence of post-surgery pressure ulcers. Furthermore, the developed protocol offers the potential to improve and strengthen the quality of surgical care in terms of both healthcare and post-surgical care. Key Words: pressure ulcer, postoperative pressure sore care, clinical care. Accepted for publication: April 14, 2015 *Address correspondence to: Shu-Fang Vivienne Wu, No. 365, Ming-Te Rd., Peitou District, Taipei City 11219, Taiwan, ROC. Tel: +886 (2) 2822-7101 ext. 2700; E-mail: shufang@ntunhs.edu.tw