褥瘡対策ケアから見えるプロセス管理

Abstract

褥瘡予防対策対象者は年々増加しており，平成29 年度から5000 件を超えている．京都市立病院の褥瘡患者の推移は，入院前発症はこの5 年間130 件前後で推移しているが，入院後新規発生は50 件前後である．当院の褥瘡有病率は1.3～1.7％で推移しており，褥瘡新規発生率は0.3～0.4％と低く，QI 事業褥瘡発生率0.03～0.04％と全国平均の0.08～0.1％を大きく下回っている．平成20 年度から皮膚・排泄ケア認定看護師が活動しており，平成28 年度から専従褥瘡管理者として褥瘡ハイリスク患者ケア加算の算定を開始している．これまでの褥瘡対策ケアを振り返り，長期的に改善への取り組みを行ってきたことをまとめた．

Patients in need of pressure ulcer measures are increasing year by year and since 2017, the number has exceeded 5,000 patients.At the Kyoto City Hospital, the number of patients who had bed sores before hospitalization was about 130 during the past5 years, and the number of patients who suffered from bed sores after hospitalization was about 50, The incidence of bed sores atthis hospital was 1.3~1.7% and the incidence of new bed sores was 0.3~0.4%. Thus, the quality indicator project rate of occurrencewas 0.03~0.04%, which is lower than the national average which was 0.08~0.1%.The nurses with certification on skin and defecation care have been active since the 2008 fiscal year. In 2016, the addition ofthe medical fee assessed for the care of patients at high risk for bed sores by full-time managers of pressure ulcers was started. Wehave reviewed the pressure ulcer measures that have been taken, and review the measures taken for improvement over a long period.