降低加護病房病人身體約束時間大於24小時之比率成效

「身體約束」為加護病房常見醫療輔助措施，約束目的在於維護病人安全及避免拔除重要醫療管路，預防超長時間約束的重點在於辨識高危險性自拔管路病人的能力、建構化學性約束護理準則、規範約束決策時機及有效稽核約束護理時數，因此必須規劃完善的約束醫療護理準則來避免超長時間約束所引發之負面影響。CPOT評估工具運用在約束照護並建立止痛、鎮靜藥物劑量使用準則，有助於避免低估病人疼痛程度，對於提升意識不清或插管病人疼痛問題之觀察能力，確實有極大幫助；另一方面，醫療團隊合作對約束決策評估作具體改善，適時稽核約束護理時數，在醫護團隊共識下，研擬出更合宜的約束照護準則，也使得專案推行後，有效降低病人約束的時間，並提供更舒適的醫療照護品質。

關鍵字

CPOT評估；止痛與鎮靜藥物；身體約束

並列摘要

The proportion of patients who were restricted over 24 hours in 2013, in Taiwan, in Shin Kong Wu Ho-Su Memorial Hospital was 69.8%, which was higher than that of Taiwan Clinical Performance Indicators (other medical centers) (52.7%). The main reason is because health-care providers can make work easier by overuse of physical restraint. However, it might cause more complications during hospitalization. Therefore, we strengthened the knowledge about chemical restraint by using critical-care pain observation tool to our patients and building the healthcare team. After these efforts, the proportion of patients who were restricted over 24 hours was reduced by 20.8%. In addition to reducing ratio of prolonged physical restraint, this project promotes the quality in healthcare.

並列關鍵字

Critical-Care Pain Observation Tool (CPOT) ； sedation therapy ； physical restraint

參考文獻

余婕榛、黃惠璣：加護病房中化學性約束的使用與護理。護理雜誌2010;57:83-8。[Yu CC, Huang HC: Chemical restraint and nursing care in the intensive care unit. The Journal of Nursing2010;57:83-8.] doi: 10.6224/JN.57.6.83

陳惠君、曾月霞、陳玉敏：中文版重症照護疼痛工觀察工具之效度檢定。護理暨健康照護研究2011;7:108-16。[Chen HJ, Tseng YH, Chen YM: Validation of the Chinese version of the Critical-Care Pain Observation Tool. Journal of Nursing and Healthcare Research 2011;7:108-16.] doi: 10.6225/JNHR.7.2.108

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Juliana B, Gilles LF, Kathleen P, et al: Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013;41:263-306. doi: 10.1097/CCM.0b013e3182783b72

被引用紀錄

洪菀琪、王筱華、柯愛鈴、鄭晴嚅（2019）。降低腦損傷重症病人身體約束發生率。榮總護理，36(3)，229-236。https://doi.org/10.6142/VGHN.201909_36(3).0002

侯怡吟、吳紋妙、林怡君、賴金敏、吳貞蓉、陳佳文（2019）。運用團隊管理資源降低內科加護病房身體約束事件之專案。領導護理，20(4)，107-122。https://doi.org/10.29494/LN.201912_20(4).0009

張憶潔、郭青秀、唐宜溱、林姿佳（2017）。降低外科加護病房連續性約束之專案。領導護理，18(1)，70-83。https://doi.org/10.29494/LN.201703_18(1).0007

劉嘉惠、張憶潔、郭青秀、謝宜珍、林姿佳、謝伶瑜、余美嬅（2020）。運用約束縮減方案照護模式於外科加護病房使用之成效。嘉基護理，20(2)，60-73。https://www.airitilibrary.com/Article/Detail?DocID=1816661x-202012-202012220011-202012220011-60-73

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降低加護病房病人身體約束時間大於24小時之比率成效

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