提升保護性約束執行正確率

A Project to Improve Accuracy Rate of Protective Restraints

本單位2011年非計畫性移除鼻胃管101件，發生率為4.2%(101/2,377)，居本院之冠，也超過2008年某醫學中心的2.2%。其中有54.46%是與保護性約束執行不正確有關。適當的保護性約束對預防「非計畫性鼻胃管移除」有其重要性，故引發筆者動機。分析2012年1-4月護理師執行保護性約束正確率僅有41.5%，導因為：保護性約束必要性正確率低(57.7%)、保護性約束工具選擇正確率低(13.3%)。單位運用團隊案例分析、發表照護經驗及體驗式教學，建立預防非計畫性鼻胃管移除約束標準。約束執行正確率由41.5%上升至100%，相關導因：保護性約束必要性及保護性約束工具選擇之正確率皆提升為100%；2012年1-4月非計畫性鼻胃管移除率由4.5%降至2013年1-4月3.3%。經由團隊共同制定的措施，可更持續落實，提升照護品質。

The unplanned nasogastric tube removal rate of our unit in 2011 was 4.2% (101/2,377), which exceeded all the units in our hospital, as well as the 2.2% of a certain medical center recorded in 2008. Among all the unplanned nasogastric tube removal, 54.46% was related to incorrect application of protective restraints. As appropriate use of protective restraint is vital in the prevention of unplanned nasogastric tube removal, the high removal rate prompted the author to investigate. In the analysis of the nurses’ application of protective restraint from January to April 2012 revealed an accuracy rate of 41.5%. The major factors contributing to the low accuracy rate were: (1) unnecessary protective restraints (57.7%); and (2) incorrect selection of protective restraints (13.3%). Our team developed a preventive standard for unplanned nasogastric tube removal based on group case discussions, care experience sharing, and experiential learning. After implementing the project, the accuracy rate of protective restraints improved from 41.5% to 100%. The 4.5% unplanned nasogastric tube removal rate from January to April, 2012, reduced to 3.3% from January to April, 2013. The preventive standard for unplanned nasogastric tube removal, a jointly developed preventive measure, is notably sustainable in its implementation, and significantly raised our nursing quality.