外傷骨折病人術後執行臨床路徑之改善方案

The Project of Utilizing Clinical Pathway to Assist Fracture Patients Recovering after Surgical Operation

某醫學中心骨科病房輔具配置的方式及時間未統一，經資料收集及分析發現病人下床及接受輔具使用之教導時間不定，臨床護理人員護理記錄未依臨床路徑呈現病人輔具配置及使用情形，加上住院時間較臨床路徑所設定之時間為長。經調查得知該單位：(1)護理人員對臨床路徑的項目認知為12.5%，且護理人員依臨床路徑執行護理相關工作者為0%。(2)缺乏配置標準流程及工作流程。(3)醫囑開立輔具配置率僅達23.3%， 時間平均為術後3天。本專案的改善措施為：(1)政策宣導。(2)護理人員教育訓練。(3)實際操作示範。(4)制定工作流程、設置術後輔具配置標準流程，統一工作流程。專案實施過程分為準備期、執行期及評值期，結果護理人員能確實運用臨床路徑，由0%提升為100%；遵循輔具標準流程及工作流程，醫囑開立輔具配置率由23.3%，提昇至90%；時間平均由術後3天提前至術後當日。由此專案結論建議該院各骨科單位宜落實推行臨床路徑的運用，以提供病人高品質的服務。

The procedure and schedule for using auxiliary device in one orthopedic unit in a medical center were not integrated. After data collection and analysis, it was found that the time for patient to get off bed and time to use auxiliary device varied. Nursing records did not record patient’s related information as per clinical path. Patient’s length of stay is longer than the standard set by the clinical path. After investigation, it was found that (1) 12.5% of nurses did not know this clinical path and no one has ever executed the clinical path, (2) no standard procedure was established in the unit, and (3) only 23.3% of the doctor’s orders showing auxiliary placement for patients and the average time was 3 days after patient’s operation. The improvement methods included: (1) policy announcement, (2) continuous education for nurses, (3) actual demonstration for nurses, and (4) policy and procedure establishment regarding auxiliary device. The project was divided into preparation, execution, and evaluation period. After implementation of the project, every nurse in the unit executed the clinical path accurately; doctor’s order of using auxiliary device increased from 23.3% to 90% and the usage started as early as the day of operation. The project indicated that it was crucial to implement the clinical path thoroughly to provide better nursing care to patients.