以團隊合作降低胸腔內科住院病人跌倒發生率之專案

住院病人跌倒會增加醫療花費、延長住院天數，也會危害照顧者和病人身心健康。本單位為胸腔內科病房，回溯2016年跌倒發生率0.06%，造成的傷害以中度為主。分析原因：病人肌力未納入跌倒危險評估因子、病人及照顧者預防跌倒瞭解程度不足、醫護人員缺乏增強肌力及平衡運動訓練、缺乏合宜衛教單張及浴室內防跌設備不足，經討論及參閱文獻後，擬定改善策略：以團隊方式參與防跌措施、修訂跌倒危險因子評估表單內容、規劃教育訓練及團體衛教、修訂防跌衛教單張、規劃肢體無力跨團隊防跌計畫、增設浴廁扶手設備後，跌倒發生率降至0.01%，病人、照顧者及醫護人員預防跌倒瞭解程度也顯著提升。透過專案建立除了加強跌倒評估高危險群之規範，更強化陪伴者預防跌倒觀念、落實病人安全預防跌倒，也顯示團隊合作和多面向的防跌措施，確實可以降低跌倒發生率，有效提升病人住院安全。

關鍵字

團隊合作；胸腔內科；跌倒

並列摘要

Patients' fall during hospitalization increases medical cost, length of stay in the hospital, and causes damage to physical and psychological health among patients and caregivers. In 2016, the incidence rate of fall was 0.06% in Thoracic Medical Ward in our hospital, and most cases suffered from moderate injury. After analyze causes include: patients' muscle strength was not included in the fall risk assessment factors; inadequate understanding of patients and caregivers in preventing falls; lack of training for medical staff to strengthen muscles and balance exercise; lack of appropriate health education leaflets and insufficient fall prevention equipment in the bathrooms. After developing the fall prevention programs by discussion and literature review in our department, the improving strategies include: participating in the fall prevention program as a team; modifying the fall risk assessment content; planning training program and group health education; modifying the fall prevention leaflets; developing plan for limb weakness across team fall prevention scheme and adding handrails in the bathroom. This study shows that the incidence rate of fall decreased down to 0.01%, and patients, caregiver, as well as the medical staffs' knowledge in relation to prevention of falls improved significantly. In addition to strengthen the standard for assessing high-risk groups through falls prevention program, it also enhances the caregiver's perception about fall prevention, and implements patients' safety in terms of fall prevention. Furthermore, it shows teamwork and multifaceted anti-fall measures, it can indeed reduce the incidence of falls and successfully improve safety of patients in the hospital.

並列關鍵字

Multidisciplinary cooperation ； Thoracic medicine ； Fall

參考文獻

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邱瓊瑩(2012) ．肺復健在慢性阻塞性肺病之重要性．血管醫學防治季刊，10，12-13。doi: 10.6527/PVM.2012.10.7

莊佳雯、曹芳馨、楊斐茹、王郁婷、吳雅婷、邱燕甘（2017）．運用跨團隊共同照護網降低住院病人傷害性跌倒發生率．長庚護理，28(4)，640-653。doi: 10.6142/VGHN.33.1.32

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黃麗靜、許美玲、袁雅怡、郭碧慧（2016）．運用團隊合作降低神經內外科病房跌倒發生率．榮總護理，33（1），32-40。doi: 10.6142/VGHN.33.1.32

國際替代計量

以團隊合作降低胸腔內科住院病人跌倒發生率之專案

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