運用組合式照護降低精神科急性病房住院病人跌倒發生率及傷害程度

Utilizing Bundle Care to Decrease the Inpatients' Fall Rates and Related Injuries in Acute Psychiatric Wards

羅翊邦(Yi-Pang Lo) ； 呂仕昀(Shih-Yun Lu) ； 蔡雅婷(Ya-Ting Tsai) ； 史捷安(Chieh-An Shih)

《精神衛生護理雜誌》 14卷2期 (2019/12) Pp. 50-61

https://doi.org/10.6847/TJPMHN.201912_14(2).05

摘要

本單位2017年跌倒發生率0.40%居全院之冠並高於醫院閾值0.20%，且有1件重度傷害跌倒事件。經歸納主要原因為篩選跌倒高危險群工具信效度低、病人預防跌倒認知正確率低、住院病人預防跌倒護理執行完整率低、醫師調藥警覺性低、病室內缺乏防跌標示、無運動時段、地板濕滑、缺乏跨領域團隊識別跌倒高危險群。藉由新增評估方式、平衡運動、彩色醒目標示、即時調整藥物、單位教育訓練之「ABCDE防跌組合式照護」成功降低單位跌倒發生率至0.15%亦降低跌倒中重度傷害的比例。專案成功之關鍵在於精神科主任加入專案小組能有效率迅速賦權，且專案小組成員藉由激勵方式使單位同仁持續推行「ABCDE防跌組合式照護」，終能提升單位優質的病人安全文化並增進照護品質。

關鍵字

組合式照護 ； 精神科 ； 住院病人 ； 跌倒發生率 ； 跌倒相關傷害

並列摘要

The psychiatric ward inpatients had a fall rate of 0.40% in 2017, the highest fall rate in the hospital. Such a fall rate was higher than that of the hospital threshold of 0.20% and there also one serious fall-related injury event happened. The main causes of the high incidence of falls and the high level of fall-related injuries could be concluded as: the low sensitivity and specificity of screening tool, the nurses' incompetent preventions for fall rates, ineffective nursing process, the inpatients' insufficient cognition to fall prevention, the doctors' lacking alertness of medication adjustment, neglecting eye-catching signs in the wards, no exercise time arranged for patients, the wet and slippery floor, and a lack of interdisciplinary team to identify the patients with high falling risks. Hence, our interdisciplinary team developed an 'ABCDE preventing-from-fall bundle care' which could decrease the fall rates to 0.15% and lower down the proportion of moderate and severe fall-related injuries. The successful key of this method relied on the whole team efforts and the director's support from the psychiatry unit to construct a unique culture for the patients' safety and better care quality in the wards.

並列關鍵字

bundle care ； psychiatric ； inpatient ； fall rates ； fall-related injuries

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