運用醫品圈手法提升腦中風病人住院期間病房復健活動執行率

Improving the Execution Rate of Bedside Exercise Programs in Hospitalized Stroke Patients by Utilizing a Healthcare Quality Improvement Circle

陳宛伶(Wan-Ling Chen) ； 賴禹璇(Yu-Hsuan Lai) ； 林聖哲(Sheng-Che Lin) ； 邱淑芬(Shu-Fen Chiu) ； 王時傑(Shich-Chieh Wang) ； 江東懋(Tung-Mao Chiang)

《醫務管理期刊》 13卷1期 (2012/03) Pp. 64-77

https://doi.org/10.6174/JHM2012.13(1).64

摘要

目的：在健保資源樽節的情形下，復健技術的進步不一定是治療品質的進步，目前仍無法以病人恢復預後來作為評估該單位復健治療的品質。因此本文的目的在呈現，透過醫品圈的運作，提出三種對策和介入模式，以量化指標來比較介入前後病人床邊復健活動執行率的差異，證明醫品圈的手法可以提高復健品質和病人滿意度。方法：個案醫院自2009年3月至2009年10月間，組成跨部門改善團隊，針對腦中風病人住院期間病房復健活動執行率不高分析其要因，並擬定改善對策。介入措施包括共同協商並選擇符合病人能力與興趣的病房復健活動，設定明確的目標，一對一教導示範及回覆示教，修訂腦中風住院病人接受病房復健活動指導標準作業流程，製作復健活動衛教單張、海報、錄影帶及照顧者填寫病房復健活動執行記錄等。結果：透過品質改善活動，病房復健活動平均執行率由對策實施前的52.3%提升至對策實施後的83.7%，整體服務滿意度由93.8%提升至100%。結論：本研究證實運用醫品圈手法，可以有效提升腦中風病人住院期間病房復健活動的執行率，進而提升臨床復健醫療照護品質。

關鍵字

腦中風 ； 床邊復健 ； 執行率 ； 醫品圈

並列摘要

Objective: The purpose of this study was to improve the execution rate of bedside exercise programs in hospitalized stroke patients by utilizing a Healthcare Quality Improvement Circle (HQIC).Method: We formed a multidisciplinary team from March to October 2009 and analyzed the factors related to the poor execution rate of bedside exercise programs in hospitalized stroke patients. We formulated several strategies to deal with this situation. These included an initial discussion with patients, the choice of proper bedside exercise programs based on each patient's interests and functional abilities, specific and definite goals, demonstration and confirmation of exercise programs one on one, modification of standard operating procedures, development of handout notes/posters/video tapes for specific programs, and the recording of bedside exercise program checklists every day.Results: The execution rate of bedside exercise programs improved from 52.3% to 83.7% and the satisfaction rate improved from 93.8% to 100%.Conclusion: Our study showed that the application of HQIC was effective in improving the execution rate of bedside exercise programs and the quality of healthcare in clinical rehabilitation services.

並列關鍵字

Stroke ； Bedside exercise program ； Execution rate ； Healthcare Quality Improvement Circle (HQIC)

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