降低外科加護病房連續性約束之專案

A Project to Reduce the Continuous Use of Restraints

身體約束在重症單位常被運用於維護病患安全及預防異常事件。本專案旨為降低連續約束率，從現況分析中發現原因有護理人員認知不足、採工作取向的價值觀、擔心管路自拔遭到懲處、缺乏與病患有效溝通的方法、缺乏提醒機制。故採取解決方案包括舉辦在職教育、約束體驗營、溝通技巧課程、分享異常事件處理經驗並邀請醫師一同參與約束照護計畫、創新製作溝通圖卡、鼓勵家屬參與照護計畫、運用提醒機制，最後不僅成功將單位病患連續約束率由56.2%降低至9.2%，期間亦無自拔管路事件發生。建議醫院及護理行政主管應加強醫護同仁約束相關的在職教育，並製造安全的環境，以減少使用約束及確保病人的安全。

Physical restraints are often used to ensure patients' safety and to prevent unexpected accidents in clinical practice. This project aimed to reduce the rate of continuous use of restraints. An analysis of use of restraints that reason of the high rate of continuous restraint, including the lack of nurses' knowledge, mining work-oriented values, fear of being punished due to accidental tubing removal, the lack of effective communication with patients, and lack of reminding mechanism. Therefore, several strategies were implemented, including in-service education, experiencing of being restraint, communication skill training, experience sharing of incident event, inviting doctors to join restraint care plan, innovation of communication cards, encouraging family to participate care plan, and application of reminding mechanism. The rate of continuous restraint was reduced from 56.3% to 9.2%, and no unplanned tubing removal occurred. It was recommended that hospitals and nursing administration should einforce in-service education and provide a secure environment in order to reduce the use of physical restraint and to ensure patients' safety at the same time.