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題名:提升病患成功脫離呼吸器之專案改善
書刊名:長庚護理
作者:張惠如邱月秋高本蓉李玉秀 引用關係
作者(外文):Chang, Hui-juChiu, Yueh-chiuKao, Pen-jungLi, Yuh-shiow
出版日期:2009
卷期:20:4=68
頁次:頁471-484
主題關鍵詞:呼吸器依賴胸腔復健脫離率Ventilator dependentPulmonary rehabilitationRatio of weaning
原始連結:連回原系統網址new window
相關次數:
  • 被引用次數被引用次數:期刊(2) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:2
  • 共同引用共同引用:0
  • 點閱點閱:104
運用胸腔復健運動以提升病患成功的脫離呼吸器,不僅可減少病患住院天數,增加病患自主能力,並可維持良好居家生活品質。本院呼吸照護中心(RCC)2005年4月至2006年3月呼吸器脫離率僅48%,平均住院天數為41天,現況調查後發現主要原因為執行胸腔復健率偏低,僅29%,造成此執行率偏低原因有:護理人員認知度僅78%、缺乏胸腔復健執行標準,以及家屬輪換率高達77%,且家屬有58%使用非中文語言,同時缺乏合適衛教工具等。本專案的目的是藉由提升胸腔復健執行率以增加病患呼吸器脫離率。經本專案小組於2005年12月至2006年6月共同擬定及推動解決方案:一、修訂呼吸器脫離路徑、胸腔復健執行標準作業流程及護理指導內容;二、製作衛教指導工具;三、舉辦教育胸腔復健訓練課程。經過本專案改善後,於2006年6-8月評值護理人員的認知度由78%提升至100%、胸腔復健執行率由29%提升至88%、呼吸器脫離率由48%提升至62%、平均住院天數由41天降至24天,換算其成本共減少57,290元/月。呼吸照護中心是未來脫離呼吸器病患的主要轉接單位,經由本專案能提早加強病患復健運動,使病患儘早脫離呼吸器,並能減少住院天數及其支出,以提升病患之生活品質。
Pulmonary rehabilitation could improve the likelihood of weaning of those ventilator-dependent patients. Not only does it shorten the duration of hospital stay, it also allows a better quality of life. The weaning rate at the Respiratory Care Center (RCC) of one teaching hospital in northern Taiwan was 48% (April 2005-March 2006) and the average length of stay (LOS) in hospital was 41 days. An observed poor execution of pulmonary rehabilitation, which was only carried out 29% of times, could be due to the lack of understanding by the nursing staff, lack of on-job training, absence of concrete procedure standards, policy, and supervision. An average score of 78% from nursing staff was obtained with regard to the overall understanding of pulmonary rehabilitation. Moreover, the rate of family member taking turns reached as high as 77%. About 58% of the family members were not native Chinese speakers. In addition, there were no appropriate tools for conducting health education. The purpose of this project was to increase the weaning rate at the RCC by increasing the execution of pulmonary rehabilitation. The strategies included revising procedure standards, developing an appropriate tool, and setting up on-job training programs Two months after the program, nurses’ understanding of pulmonary rehabilitation improved to 100% and the execution rate increased to 88%. The ventilator weaning rate increased from 48% to 62%, LOS decreased to 24 days, translating to an average saving of NT$ 57,290 per month in hospitalized. The RCC is the transfer unit to improve the outcome of ventilator-dependent patients. Optimized strategies targeting education of nursing staff on aspects of pulmonary rehabilitation may improve the outcome of ventilator-dependent patients, such that improved the possibility of weaning, shortened duration of hospital stay, less hospitalization expenses, and better quality of life could be obtained.
期刊論文
1.American Thoracic Society(1995)。Standards for the Diagnosis and Care of Patients with Chronic Obstructive Pulmonary Disease and asthma。American Journal of Respiration and Critical Care Medicine,152,77-120。  new window
2.李俊德、陳寶貝、林若華(2003)。長期使用呼吸器。呼吸治療期刊,2(1),21-26。  延伸查詢new window
3.蘇千玲、楊式興、吳清平(20050000)。臺灣呼吸照護整合系統現況與未來。臺灣呼吸治療期刊,4(1),57-62。  延伸查詢new window
4.侯清正、鄭高珍(20021000)。手術後呼吸衰竭的機轉與處置。中華民國重症醫學雜誌,4(4),279-286。  延伸查詢new window
5.邱艷芬、唐修平、曾詩雯(20030700)。改良式腹式呼吸法促進慢性阻塞性肺疾病患肺功能與活動能力之效果。臺灣醫學,7(4),492-501。  延伸查詢new window
6.石季子、李靜華、劉麗芳(20050600)。一位全身紅斑性狼瘡病患脫離呼吸器之護理經驗。領導護理,6(1),63-74。  延伸查詢new window
7.宋美儀、謝俊民柯獻欽、鄭高珍(2003)。建立呼吸照護中心呼吸器脫離之預測指標。中華名國重症醫學雜誌,5(3),189-198。  延伸查詢new window
8.范聖心、陳清惠(2006)。一位肺葉切除術後病患執行肺部復健運動之成效探討。長庚護理,17(3),377-387。new window  延伸查詢new window
9.莊雅婷、白玉珠(2003)。一位肢障患者長期使用呼吸器之脫離經驗。慈濟護理,2(4),95-104。  延伸查詢new window
10.盛德芳(1999)。肺部復健應用於一位支氣管擴張症患者的護理經驗。長庚護理,10(4),50-54。new window  延伸查詢new window
11.黃卓禕、葉素玉、黃智裕、李俊年、江玲玲(2005)。插管病人呼吸器脫離之生理預測指標。呼吸治療期刊,4(1),90-99。  延伸查詢new window
12.邊苗瑛(2004)。人工氣道留置病患呼吸道分泌物的處理。呼吸治療期刊,3(1),78-90。  延伸查詢new window
13.Andreas, V. L., Erika, H.,、Karin, T.(2008)。Effects of 3-week outpatient pulmonary rehabilitation on exercise capacity, dyspnea, and quality of life in COPD。Lung,186,387-391。  new window
14.Chang, A. T., Boots, R. J., Brown, M. G., Paratz, J.,、Hodges, P. W.(2005)。Reduced inspiratory muscle endurance following successful weaning from prolonged mechanical ventilation。Chest,128(2),553-559。  new window
15.Chang, A. T., Boots, R. J., Henderson, R., Paratz, J. D.,、Hodges, P. W.(2005)。Case report: Inspiratory muscle training in chronic critically ill patients-a report of two cases。Physiotherapy Research International,10(4),222-226。  new window
16.Michele, V., Luca, B., Maria, S., Mara, P.,、Bruno, B.(2006)。Physiological responses to arm exercise in difficult to wean patients with chronic obstructive pulmonary disease。Intensive Care Medicine,32,1159-1166。  new window
17.Naji, N. A., Connor, M. C., Donnelly, S. C.,、McDonnell, T. J.(2006)。Effectiveness of pulmonary rehabilitation in restrictive lung disease。Journal of Cardiopulmonary Rehabilitation,26(4),237-243。  new window
18.Padula, C. A.、Yeaw, E.(2006)。Inspiratory muscle training: Integrative review。Research and Theory for Nursing Practice,20(4),291-304。  new window
19.Ries, A. L., Bauldoff, G. S., Carlin, B. W., Casaburi, R., Emery, C.F., Mahler, D.A., et al.(2007)。Pulmonary rehabilitation: Joint ACCP/AACVPR evidence-based clinical practice guidelines。Chest,131,4-42。  new window
20.Severo, V. G.,、Rech, V. V.(2006)。Pulmonary Rehabilitation: Upper-limb exercise training in patients with COPD。Fisioterapia Pesquisa,13(1),44-52。  new window
學位論文
1.胡淑琴(2004)。探討吸氣肌肉訓練對呼吸器依賴患者之脫離成效,花蓮。  延伸查詢new window
2.劉淑芳(2004)。下床坐椅對呼吸器依賴病患脫離呼吸器之成效探討,台中。  延伸查詢new window
圖書
1.王桂云、李惠玲(2007)。呼吸系統疾病護理。成人內外科護理(四版)。台北:華杏。  延伸查詢new window
2.林美良(2002)。呼吸功能失償。內外科護理學。台北:華杏。  延伸查詢new window
 
 
 
 
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