醫院病歷室工作人員肌肉骨骼不適之評估-以南部某教學醫院為例

隨著醫學和科技日益進步，以及新制醫院評鑑的成立，使得醫院的經營理念著重在病人權益和追求卓越品質上，但是許多研究報告均顯示醫院工作者面臨的危險機率可能會高於其他一般工作環境，因此在工作中導致的疾病傷害比例也會隨之增加，過去有關護理人員人因危害分析之研究很多，但是沒有針對病歷室工作人員的研究。本研究目的在評估病歷室工作人員之肌肉骨骼不適問題及發生之風險因素，並且提出改善建議。研究對象為醫學中心之病歷室工作人員，共計209位以主觀性問卷調查為主。研究方法共分為三大部分：第一部分，使用問卷以了解病歷室工作人員肌肉骨骼不適資料；第二部份，進行作業觀察分析與BRIEF人因檢核表評估，以了解高風險之作業及影響之身體部位；第三部份，進行生物力學評估以獲取更深入的分析資料。研究結果顯示，病歷室工作人員自覺肌肉骨骼任不適之盛行率為85.0%，問卷調查肌肉骨骼不適之盛行率以肩膀(88%)、頸部 (75%)、手腕(62%)等三個部位較高，BRIEF檢核表評估在手及手腕、肩膀、頸部有較高風險，和問卷的結果是一致的；在和不同等級醫院做比較，除了休息時間有差異，其他肌肉骨骼不適和部位都沒有達到顯著差異；和行政人員做比較，肌肉骨骼不適和部位都有達到顯著差異，代表工作內容不同。生物力學評估發現在抬舉動作方面，有部分作業超過行動限度；在推拉動作方面，發現在不同作用高度下二頭肌和三頭肌受的力沒有太大的相關。從各項研究資料顯示病歷室人員的工作，可能會使許多身體部位發生肌肉骨骼不適。因此建議從行政管理上調整休息時間分配以及人力分配，從作業上修改作業姿勢以及制定工作準則，和在教育訓練方面可加強人因工程觀念，運用正確方法去進行各種作業。

關鍵字

病歷室人員；人因危害；肌肉骨骼不適； BRIEF檢核表

並列摘要

In recent years, as Hospital Accreditation developed and with it the management idea of a hospital that pay more attention to the patients and medical care quality. In the past years, many researches discussed about ergonomic hazards for the nursing staff but few for medical records Staffs. So, the aim of this study is to do ergonomic hazards analysis of medical records Staffs and propose improvements. The subjects of this study were 209 from eleven hospitals. Three parts of this study were: 1) collecting musculoskeletal disorder data by a questionnaire, 2) investigate high risk task by job analysis and 3) using ergonomics checklist (BRIEF) and biomechanics instruments to do ergonomic hazards analysis. The results of questionnaire showed higher musculoskeletal disorder prevalence were in shoulder (88%), neck (75%) and wrist (62%). The result of BRIEF showed higher risks in the segments of shoulder, neck and hand/wrist. Based on the data of questionnaire, the result of BRIEF was consistency. By biomechanics assessments, the L5/S1 disc of spine has been found over loading the action level when subjects performed some lifting tasks. By comparing the biceps and triceps activities of different height, we found they are not significant. The results showed that the tasks of medical records Staffs may occur musculoskeletal disorder. The recommendations to prevent the ergonomics hazards of the workers were adjusting the distribution of rest time and manpower from administration, revising the posture of the task and making job principle and enhance ergonomic knowledge to do their job correctly by training.