提升某加護中心護理人員執行身體約束護理之正確率

Improving the Accuracy Rate of Physical Restraint Application at an Intensive Care Unit

隨著病患安全及醫療品質日受重視，關於身體約束之執行，美國JCAHO及國內醫院評鑑對此指標項目皆有訂定明確之標準，此外，也要求醫療機構重視並制訂相關之處置規範。而本單位身體約束事件發生頻繁，審視現行之處置規範中諸多要點已未能符合實證要求，致使護理人員在執行約束過程中常未能符合標準，因此成立專案小組藉由重新修訂其處置標準及制訂約束護理評估單張並宣導推行後，以身體約束使用狀況調查表調查單位內實行約束護理的狀況發現，身體約束護理之正確率（包含鬆緊度適當、約束無造成損傷、固定處適當、適時暫予鬆除約束及進行護理評估、約束紀錄）已由31.6％提升至93.4％。最後也期望本專案之結果可提供臨床於執行身體約束護理時做一參考。

Recently, along with the increasing importance on patients rights, safety and quality of health care, the Joint Commission on Accreditation of Healthcare Organization (JCAHO) and the hospital assessment items all have established/ revised specific guidelines on the application of physical restraint. Moreover, they also strongly request medical units recognize this issue and expect further specification on related instructions. Physical restraint in our unit was occurred frequently and we were unable to reach the evidence-based requirement after scrutinizing the approaches and guidelines applied for the patients. As a result, the nursing staff failed to meet the standard at the restraint process. Therefore, this project intended to revise the standard operation of restraint and design a customized assessment sheet in order to improve the accuracy of restraint application. After implementing, the overall accuracy rate, including the evaluation of location suitability, injury occurrence, restraint band tension, nursing assessment and written restraint record, increased from 31.6 percent to 93.4 percent. The finding of this project can provide a clinical reference at the use of physical restraint.