運用團隊管理資源降低內科加護病房身體約束事件之專案

醫護人員為顧及急重症病人及週遭人員安全採取身體約束，但長時間約束會導致病人身心傷害，因本單位2016年身體約束事件為8.84%，超過護理部訂定閾值6.85%，專案目的為降低加護病房病人身體約束事件。現況分析因護理人員對身體約束認知不足、和病人間無溝通輔具、缺少重症止痛鎮靜評估工具及缺少團隊提醒機制。故專案舉辦在職教育溝通圖卡、創新鎮靜止痛照護指引轉盤，並每日運用提醒機制警示牌，與ISBAR交班溝通技巧（Introduction, Situation, Bacground, Assessment & Recommendation）和醫療團隊討論、結合團隊交班平台與醫囑資訊化，執行後身體約束事件由8.84%下降至5.3%，但單位以氣管內管病人居多，易有急性譫妄發生，建議應針對譫妄有所評估及預防，納入每日照護，以增進病人安全與品質。

關鍵字

身體約束；團隊資源管理；鎮靜止痛

並列摘要

Physical restraints are often adopt by medical staff when considering critically ill patient and safety of surrounded people, however long-term restraints can cause physical and mental harm to the patient. The physical restraints incidence rate in our unit was 8.84% in 2016. It exceeded the threshold set by nursing department at 6.85%. This project aims to reduce physical restraints in the intensive unit. Recent analysis points out insufficient knowledge of physical restraints, the lack of effective communication with patients, shortage of severe analgesia and evaluation tools, as well as team reminder mechanism. Consequently, several strategies were adopted, including organize on-the-job education with communication picture cards; invent new sedation pain care guidelines turntable; daily reminder mechanism involving ISBAR for discussion with medical team, and combined team handover platform with information on medical advice. After the execution, the rate of physical restraint was reduced from 8.84% to 5.3%. Although there are more intubated patients in the ICU and acute delirium occurs frequently. Healthcare professionals shall assess and prevent delirium as recommend, and inclusion of daily care to improve patient safety and quality.

並列關鍵字

physical restraints ； team resource management ； sedation pain

參考文獻

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吳純怡、陳明怡、賴寶琴、林鎮均（2016）‧降低加護病房病人身體約束大於 24 小時之比率成效‧台灣醫學，20(2)，189-194。doi:10.6320/FJM.2016.20(2).8

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李綺婷、陳嘉明、顏雅卿、謝志松（2013）‧團隊資源管理模式降低內科加護病房非計劃性移除氣管內管之成效‧呼吸治療，12(1)，15-22。doi:10.6269/JRT.2013.12.1

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運用團隊管理資源降低內科加護病房身體約束事件之專案

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