運用實證護理改善兒科跌倒發生率

Using Evidence-based Nursing to Improve the Incidence of Pediatric Falls

洪嘉玟(Chia-Wen Hung)

《新臺北護理期刊》 23卷2期 (2021/09) Pp. 89-100

https://doi.org/10.6540/NTJN.202109_23(2).0008

摘要

兒科跌倒評估和預防策略的研究有限，發生率也比成人略低，但跌倒易造成病童生心理不適及照顧者照護壓力。分析兒科病房平均跌倒發生率為0.06%，係因病童的認知及發展不成熟、步態不穩及平衡感差；照顧者低估跌倒的風險，執行預防跌倒正確率低；醫護人員未落實指導，資訊系統沒有明確的高危跌倒病童標示及稽核制度的未落實。故經由實證護理的五大步驟，搜尋分析實證文獻，結合醫療團隊將實證措施於2018年10月20日至2019年12月20日於兒科病房實施：設置提醒照顧者的防跌警示、運用防跌衛教輔助工具進行衛教、執行照顧者跌倒風險的反思情境衛教、使用獎勵機制激勵病童及照顧者共同執行防跌，並在跨團隊共同進行家屬提醒及指導下，落實執行兒科防跌的監控機制。專案結果顯示兒科跌倒發生率降至0.00%，照顧者執行跌倒預防正確率由79.0%提升到96.2%，護理人員執行預防跌倒正確率由80%提升到100%，兒科醫師跌倒衛教執行率由12.5%提升至100%。病童及照顧者能落實執行預防跌倒措施，醫護人員能警覺高危跌倒病童及時提供指導及評值，增進兒科醫護工作環境的防跌氛圍，現已平行推展到兒童加護病房，共同維護兒科病童安全及良好照護品質。

關鍵字

實證護理 ； 兒科 ； 跌倒發生率

並列摘要

Studies of pediatric fall assessment and prevention strategies are limited, although the incidence is slightly lower than that of adults. Falls can easily cause psychological discomfort on sick child and pressure on caregivers for hospitalized children. The average incidence of falls in the pediatric ward was 0.06% due to immature cognition and growth, unstable gait, and poor balance of sick children. Caregivers underestimated the risk of falls and there was low correct rate of implementing fall prevention. Even more, medical staff did not earnestly follow guidance. Sick child with high-risk falls was unclearly marked in information system and audit system was not carried out exactly. Therefore, through five steps of empirical nursing and search evidence-based literature, we combined with the results of evidence-based literature and team help to implement improvement measures from October 20, 2018 to December 20, 2019, including establishing fall prevention warnings, using prevention fall health education aids for health education, implementing health education of fall risk self-reflection for child caregiver to recognize the risk of falling in a self-reflective context, and adopting reward mechanism to encourage the sick child and caregiver to perform together. After cross-team cooperated to implement reminding, guiding and monitoring on family members and nursing staff to execute the fall prevention mechanism, the results showed that the incidence of pediatric falls fell to 0.00%. The accurate rate of caregiver's fall prevention increased from 79.0% to 96.2%. The accurate rate of fall prevention by nursing staff increased from 80% to 100%. The implementation rate of fall education in pediatrician increased from 12.5 % to 100%. Sick children and caregivers implemented exactly fall prevention measures, and medical staff were aware of high-risk falls and provided timely guidance and evaluation to enhance the fall prevention atmosphere in pediatric medical work environment. We promoted above implementation to pediatric intensive care unit to maintain the safety and good care quality for hospitalized children.

並列關鍵字

evidence-based nursing ； pediatric ； falls

參考文獻

中央健康保險局、財團法人國家衛生研究院、財團法人醫院評鑑暨醫療品質策進會（2004）。臨床診療指引發展手冊：臨床流行病學方法之應用。台北：九十二年度中央健保局委託研究計劃報告。

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