- 期刊
- OpenAccess
降低加護病房病人持續超長被約束之成效
The Effectiveness of Reducing the Patients with Physical Restraint over 24 Hours in the Cardiac Care Unit
摘要
本單位（心臟內料加護病房）病人連續被約束時間長於24小時的比率約53.89%，高於本院其他各加護單位的38.61%及全院的45%，同仁不論病人是否能合作或意識清楚，只要身上有重要管路皆會持續約束直到管路拔除，亦曾因病人被持續約束導致手部合併症而引起醫療糾紛，為避免再發生類似情形及降低連續被約束率，經現況分析後發現問題為護理人員：1.約束已成為習慣性直接反應，2.缺乏識別病人為自拔管路高危險群的能力，3.擔心發生管路自拔意外事件而受到處罰。採用的改善策略為：1.教育課程：舉辦約束體驗及決策評估課程，教育同仁正確約束知識及如何判斷自拔管路高危險群，2.制定正確約束決策流程，進行約束護理稽核，3. 鼓勵及宣導同仁免責通報異常事件，4.納入醫師，共同分析與討論不適當約束事件等。經執行策略半年，連續被約束時間長於24小時的比率下降至11.5 %，持續平均維持於7.03%，效果比預期結果好，病人亦未發生約束合併症。
並列摘要
The reduction in the use of physical restraints is an important indicator of the quality of patient care. Physical restraint events, ＞24 hours, happened frequently (53.89% from January to June in 2008) in the cardiac care unit (CCU).Interview with CCU nurses unveiled that regardless of whether a patient was able to cooperate or not, nurses used physical restraint until patients' invasive devices were removed. For this reason, we conducted an action team, and the purpose of the study is to develop a project in order to minimize physical restraint events lasting more than 24 hours and improve the quality of care. The project applied interdisciplinary methods and contained four strategies including: 1) education programs, such as sharing restraint experiences and decision making, plans of restraint substitution, and notice of patients who were high-risk of unplanned extubations, 2) forming the protocols of physical restraint, 3) encouraging staff to report any incident, 4) analyzing and discussing inappropriate physical restraint events. We compared the incidence of 24-hour physical restraint in the following four months after the project was carried out. After the project was done, the episodes of physical restrain were much fewer. The average percentage of continuous physical restraint greater than 24 hours was 11.5% from November in 2008 to April in 2009, and 7.03% from May to December in 2009. Consequently, staff chose physical restraints as an alternative. Patients didn't incur any complications caused by the physical restraints.