氧氣治療是肺部疾病常見的治療方式之一，是維持生命的重要設備，氧氣面罩設備需緊密地固定在病人臉部，長期使用下皮膚或黏膜上可能產生與醫療器材相關壓力性損傷，統計胸腔科住院病人2018～2019年有39件，因使用非侵入性用氧設備，導致臉部及耳部產生壓力性損傷，發生率為0.055%，故引發專案改善動機。於2020年2月成立專案小組，專案成員參考依據臨床處置規範及預防醫療器材相關壓力性損傷之實證建議進行臨床觀察及現況分析，確認導致非侵入性用氧相關壓力性損傷的原因有：現行壓傷危險因子評估表不適用、固定帶鬆緊度調整不適當、現有氧氣面罩固定帶過細、未提供剪裁合適的減壓敷料、未落實非侵入性用氧設備下的皮膚評估及非侵入用氧相關壓力性損傷的評估與照護認知不足。專案成員於2020年5月至11月透過系統性評價擬訂改善對策：（一）增修醫療器材壓傷風險評估說明；（二）設計測量鬆緊度工具；（三）創新「金惜皮氧氣面罩專用帶」；（四）制定醫用尺規版應用於減壓敷料之執行辦法；（五）製作氧氣面罩壓迫部位皮膚提醒圖；（六）規劃非侵入性用氧相關壓傷評估與照護相關課程。專案執行6個月後，壓傷發生率降至0%，非侵入性用氧相關壓力性損傷認知平均正確率由改善前52.3%提升88.7%，病人家屬及護理人員滿意度達100%，有效預防非侵入性用氧相關壓傷，提升護理人員非侵入性用氧相關壓傷照護認知，提升病人家屬滿意度及降低醫療成本。期望將此專案經驗建構非侵入性用氧病人預防壓傷之多元策略及創新照護模式，提升照護品質。
Oxygen therapy is one of the most common methods for treating lung disease and can be vital in maintaining life. An oxygen therapy device must be fixed tightly and safely to be effective. Device-related pressure injuries to the skin or mucous membranes can occur as a result of long-term use of oxygen therapy devices. In 2018 and 2019, 39 inpatients in a chest ward (0.055%) had device-related pressure injuries to the face or ears caused by the use of oxygen masks or catheters, indicating the need for improvement in correctly and effectively fixing these devices. Consequently, a task force was established in February 2020. Using a checklist to analyze the current situation and to verify the causes of such injuries, we found that the current clinical treatment standards did not include clear assessment items or measures to prevent iatrogenic pressure loss, did not recommend skin assessment at the site of iatrogenic pressure loss, lacked protective measures related to oxygen masks, and lacked consistency regarding recommended mask tightness. Accordingly, project members formulated improvement countermeasures through systematic evaluation from May to November 2020: (1) update the description of the pressure injury risk assessment of medical equipment, (2) design a tightness measurement tool, (3) innovate the "special belt for oxygen masks", (4) develop implementation methods for medical rulers to be used in pressure relief dressings, (5) make skin reminder diagrams of oxygen mask compression areas, (6) plan courses related to noninvasive oxygen-related pressure injury assessment and care. Six months after the project was implemented, the incidence of pressure injuries dropped to 0%, and the average accuracy of cognitive recognition of noninvasive oxygen-related pressure injuries increased from 52.3% before improvement to 88.7%. Effectively prevent noninvasive oxygen-related pressure injuries, improve nursing staff's awareness of noninvasive oxygen-related pressure injuries, improve patient family satisfaction and reduce medical costs. It is hoped that the experience of this project will be used to construct multiple strategies and innovative care models for preventing pressure injuries in noninvasive oxygen patients, and to improve the quality of care.
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