提升呼吸器依賴病人肺部復健執行率之專案與初步成效

Preliminary Results of a Pulmonary Rehabilitation Exercise Program for Ventilator Dependent Patients

本文係運用跨團隊合作提升呼吸器依賴病人肺部復健運動之成效，並藉此增加病人呼吸器脫離成功率。專案動機係因本單位執行此類病人肺部復健運動執行率僅達32.8%，原因有單位缺乏肺部復健運動照護規範、護理師不清楚病人個別復健目標、肺部復健運動認知不足、尖峰時段工作負荷大，擔心獨自執行運動與管路安全性不足、家屬肺部復健資訊來源不足、項目多記不住。運用de Morton Mobility Index工具，評估病人最佳功能活動，由物理治療師評估病人轉入及轉出病房的進步活動分數。另一方面，專案成員藉由制訂肺部復健照護規範、製作個別化運動進度海報與護理指導海報、舉辦在職教育、重整病人照顧服務員工作內容，並加入肺部復健運動及制訂執行復健之獎勵辦法、舉辦家屬肺部復健運動團體衛教課程、拍攝肺部復健運動護理指導影片。經實施改善後肺部復健運動執行率由32.8%提升至83.4%，呼吸器脫離率由42.9%，提升至52.9%，平均住院天數由24.7天下降至20.5天。建議未來如能落實跨團隊合作執行此類病人肺部復健運動，使病人儘早脫離呼吸器，以提升醫療品質及其生活。

This report describes an improvement program to enhance the pulmonary rehabilitation exercise rate for ventilator-dependent patients by the implementation of a multi-disciplinary teamwork approach in dedicated respiratory care center. The main reasons for a low before-implementation pulmonary rehabilitation performance rate of 32.8% included a lack of pulmonary rehabilitation care standards, unclear goals for individual patient rehabilitation, insufficient patient's awareness of pulmonary rehabilitation, long periods of peak workload, staff's worrying about unassisted training and tube safety, insufficient information about pulmonary rehabilitation, lack of adequate memory about rehabilitation items. The physiotherapist applied the de Morton Mobility Index tool to evaluate the patient for the best functional activity, and the improvement of activity scores upon admission and discharge. The improvement strategies included developing a standardized process for pulmonary rehabilitation, poster display of individualized rehabilitation schedule and nursing care, staff in-service education, recruitment and encouragement of nursing assistants into pulmonary rehabilitation, conduct pulmonary rehabilitation health education, videos for pulmonary rehabilitation care guide. After the implementation of the above strategies, the execution rate of pulmonary rehabilitation increased 32.8% to 83.4%, whereas the weaning rate increased from 42.9% in 2014 to 52.9% in 2015. There was also a reduction of the length of hospital stay from 24.7 days in 2014 to 20.5 days in 2015. Our results suggest that multidisciplinary teamwork cooperation might be implemented in the pulmonary rehabilitation for the ventilator-dependent patients in an attempt to earlier weaning off from the ventilator, improving quality of care and enhancing the their quality of life.