提昇病人使用連續被動運動器正確性之改善方案

The Project of Improving Accuracy of Patient’s Operating Continuous Passive Motion Equipment

連續被動運動器(continuous passive motion, CPM)，用於外傷、手術、人工膝關節置換術後或因疾病導致膝關節活動受限的病人；提供被動式膝關節活動避免膝關節僵硬，是重要的復健輔助醫療器材。筆者服務的單位常見因儀器使用分配問題產生抱怨與爭執。經資料收集後發現每台運動器每天使用時數高達10小時以上，使用人數平均2～3人/每天/每台；同時發現請修次數頻繁，依2005年年度請修紀錄統計呈現每月送修總次數平均5.5次/6台，最高達10次，且耗時3～14天，請修頻率高於其他醫療儀器項目。經現況資料收集調查確立問題為護理人員對連續被動運動器的儀器操作認知僅達77.8％，儀器操作正確率僅達75％，病人及家屬操作正確率69％。透過本專案改善提供人員在職教育，設置簡易操作流程圖及故障排除步驟，作為護理人員及病人與家屬操作時之參考。並訂定持續性監測機制確保人員認知及操作步驟之正確性。專案實施分準備期、執行期及評值期，實施後護理人員對連續被動運動器認知率和操作正確率皆達100％；病人及家屬操作的正確率也達92％。6～8月儀器請修次數由改善前平均每月5.5次降至每月平均2次。專案改善結果顯著，在提高病人服務品質的同時，也能降低成本，期望此改善方案能提供有使用此器材之單位參考。

Continuous Passive Motion (also called CPM) equipment is used for patients with knee trauma, after knee operation, after total knee replacement operation, or with knee limitation due to disease. It is important to provide passive knee joint exercise to prevent synarthrosis. It is also common to see conflict between patients while using CPM equipment in orthopedic unit. It is found that each CPM equipment was used for 10 hours averaging 2-3 patients per day and was sent to repair up to 10 times and averaging 5.5 times for 3-14 days per month for the year of 2005 in our orthopedic unit. Data showed that nurse’s knowledge about operating CPM equipment was 77.8%.Nurses’ accuracy of operating CPM equipment was 75%. Patient and family’s accuracy of operating CPM equipment was 69%. After providing continuing education for nurses, establishing flow chart of operation and malfunction exclusion process for nurses, patient and family, and installing continuing monitoring mechanism through preparation, execution and evaluation period, the nurse’s knowledge on accuracy of operating CPM equipment and nurse’s accuracy of operating CPM equipment had reached to 100%. Patient and family’s accuracy of operating CPM equipment had reached to 92%. The average number of repairing of CPM equipment was down from 5.5 times to 2 times per month. This project has positive influence on improving quality of care and decreasing overall cost.