- 期刊
提升呼吸照護中心護理人員翻身擺位正確率之專案
Implementation Project to Enhance the Accuracy of Turning and Positioning by Nursing Staff in Respiratory Care Center
摘要
2020年10月本單位護理師在協助病人會陰沖洗翻身擺位過程中，因病人肢體關節僵硬，護理師欲使其髖關節外展，以單手外推膝關節，造成病人發生骨折，引發專案動機。經現況分析，發現呼吸照護中心護理人員翻身擺位正確執行率低，主要導因為：缺乏簡易評估自發性骨折工具、缺乏警告標示、照護指引內容未參照預防自發性骨折概念、缺乏翻身擺位教育訓練及無稽核制度。專案小組以建立骨質疏鬆高風險評估量表、警告標誌、修訂病人轉入照護流程、翻身擺位暨床上身體清潔標準作業流程、錄製教學影片、舉辦相關教育訓練及稽核制度等措施進行改善。實施後翻身擺位認知正確率由75.2 %提升至98.1 %、照護技能由65.2 %提升至93.8 %。藉由專案進行工作流程檢視與教育訓練，改變人員翻身擺位照護的行為，進而提升照護品質與病人安全。
並列摘要
In October 2020, when a nurse in our unit provoked a patient to suffer fracture while performing with perineum washing and turning over with patient's stiff joints. The nurse attempted to rotate the patient's hip joint outwards and pushed the knee joint with one hand resulting in the fracture, consequently prompting this project. After analyzing the current situation, it was found that the correct implementation rate of nursing staff in the respiratory care center is low, main reasons include: lack of simple tools to assess spontaneous fractures, lack of warning signs, care instructions that do not refer to the concept of preventing spontaneous fractures, lack of education and training on turning and positioning, and there were no audit system. The project team made improvements by establishing a high-risk assessment scale for osteoporosis, warning signs, revising patient transfer processes and turning position; body cleaning standard procedures, recording instructional videos, conducting relevant education and training, as well as implementing audit system. After implementation, the cognitive accuracy rate of turning over and positioning increased from 75.2% to 98.1%, and the nursing skills rating improved from 65.2% to 93.8%. Through implementation of the project for process review and educational training, the behavior of staff when turning over patients, and positioning skills had restored, thereby improving the quality of care and patient safety.