股骨骨折患者術後延遲復健的改善方案

The Plan to Promote the Initiation to Leave the Bed for Rehabilization in Postoperated Patients Suffering from Femoral Fracture

股骨骨折接受手術之後，及早下床復健是早日復原的唯一途徑；長期的臥床不但無助於復原，更易誘發種種的併發症，甚或喪命。2004 年1 月的一項調查中，我們發現患者與家屬的認知不足、護理人員的專業素養不足、以及護理行政督導的疏忽，是導致骨折患者術後延遲下床的主因。針對於此，我們依循PDCA 的解決模式，提出改革方案；明訂首次下床時間、製訂專業協助告示牌、明確劃分專業協助的責任歸屬、建立稽核制度、舉辦在職教育訓練、製訂護理指導手冊、積極進行床邊衛教與護理協導，而獲得明確的改善效果。在本方案執行前，骨折患者術後首次下床時間為141±4.9 小時（平均值± 標準差），執行中為98.1±3.3 小時，執行後則明顯的降至69.0±2.7 小時（F test,P ＜ 0.01）。患者對於及早下床復健，在認知上的錯誤或不足，在本方案執行前為100%，執行後則降至13%。本方案的推行是成功的，因此我們將本方案的持續執行，納入日常護理行政的SDCA 管理內涵。日後，我們將能持續地監控：骨折患者術後早期復健的狀況。

To leave the bed for early rehabilization as soon as possible after the surgical manipulation is the best but the only way to recover completely or almost completely for postoperated patients suffering from femur fracture. Prolonged bed-lying is not only harmful for early recovery, but also usually leads to complecation(s) of various severity, even results in a lethal outcome. We has found the leading causes of a prolonged bed-rest after surgery for the femur-fratured patients included patients/family misconcept and/or mis-knowledge, nurses undergone incomplete professional education and/or training, and inadequate central supervision. We thereafter, according to the PDCA principle, demonstrated a new system, a complete plan, showing an accurate definition of initiation time to leave the bed after surgery, a claim-board of professional aids, a clear-cut responsibility for postoperative professional aids, a complete supervision system for follow-up, an intensive in-job continuous training course, a guidebook in detail for initiation on postsurgery rehabilization, and an active bed-side professional aiding system. With the performance of the new system, the t-time (the initiation time to leave the bed postoperatively) was prominently shortened from 141±4.9 hours to 69.0±2.7 hours (p＜0.01); and, the percentage of patients/family with misconcept/mis-knowledge was changed from 100%(30/30) to 13%(4/30). Undoubtedly, our plan was successfulin its promoting phase. This new system is now carried out as a rule for an ordinary daily management mode, under the SDCA priniciple.