提升骨科下肢手術病人48小時下床達成率

背景：下肢骨折術後病人經實證建議在術後48小時內早期下床可有助於肌力恢復，能增加活動能力減少臥床合併症。調查發現本單位下肢手術病人術後48小時內首次下床達成率僅39.6%，造成病人因肢體無力抱怨下床過程困難、增加家屬照顧負擔及延遲出院，故成立專案小組改善。目的：提升下肢手術病人48小時內下床達成率，改善術後生活品質。解決方案：透過製作下床活動進度提示看板，由醫師擬定進度，由醫療團隊告知執行重要性；製作早期下床及復健運動影片；擬定下肢術後活動標準流程；增設單位輔具；舉辦協助下床在職教育訓練進行改善。結果：下肢手術病人術後48小時首次下床達成率由39.6%提升至96.8%。結論：本專案於臨床工作可有效改善病人術後肌力維持、增進日常活動機能，進而提升手術後生活品質減少住院天數。盼此專案改善可作為手術後病人照護參考。

關鍵字

早期下床；骨科；手術

並列摘要

Background: Evidence-based recommendations for patients after surgery for lower extremity fractures, getting out of bed early within 48 hours after surgery can help recover muscle strength, increase mobility and reduce bed rest complications. The survey found that only 39.6% of the lower limb surgery patients got out of bed for the first time within 48 hours after surgery in our ward, patient complained about the difficulty of getting out of bed due to limb weakness, increased family care burden and delayed discharge, so a task force was established to improve it. Purpose: This project aims to reduce the first time out of bed in 48 hours, and postoperative quality of life for lower limb surgery patient. Project plans: Through the production of the progress reminder board for getting out of bed, the doctor will draw up the progress, and the medical team will inform the importance of implementation; make early getting out of bed and rehabilitation exercise videos; formulate the standard procedure for lower limb postoperative activities; add assistive devices to the ward; organize on the job education and training to assisted getting out of bed to ameliorate. Results: The results revealed that rate of patients getting out of bed within 48 hours after lower limb surgery increased from 39.6% to 96.8%。 Conclusion: The clinical work of this project can effectively improve the maintenance of postoperative muscle strength and daily activities of patients, thereby improving the quality of life after surgery and reducing the number of days of hospitalization. It is expected that this project will be improved as a reference for post-surgical patient care.

並列關鍵字

Early ambulation ； orthopaedics ； surgery

參考文獻

丁睿宇、陳彥方、陳慧娟、黃冠樺、高木榮（2019）‧髖關節骨折急性後期復健照護之長期成效‧北市醫學雜誌，16(3)，220-231。https://doi.org/10.6200/TCMJ.201909_16(3).0005

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