運用多元策略降低病人身體約束事件發生率

Multiple Strategies to Reduce the Incidence of Physical Restraints

在重症單位為了維護病人安全與預防意外事件發生，常需要執行身體約束，然而不當之身體约束可能造成病人身心之傷害。從2014年起本單位身體約束事件發生率均比臺灣臨床成效指標計畫醫學中心同儕值2.17％高，故成立專案小組尋求改善策略。經分析身體約束事件發生率高之原因：1.護理師認知不足與害怕承擔風險；2.病人躁動與重要管路留置；3.欠缺具體約束原因之判定準則；4.替代約束用具種類不足。改善策略為舉辦在職教育課程、制定身體約束評估流程圖和身體約束高危評估量表、研發替代約束用具「金剛臂」與溝通輔具。專案實施後，發生率由4.04％降至0.76％，改善率高達81.18％，也無導管滑脫與跌倒事件，成效良好。未來期望此專案措施能平行推展至各病房，促進重症單位之照護品質。

Physical restraints are often employed to maintain patient safety and prevent events in intensive care units; however, physical and psychological harm to the patients may occur because of inadequate use of restraints. Since 2014, the incidence of physical restraint of our unit was higher than the average level of 2.17% for peer medical centers according to the Taiwan Clinical Performance Indicator system; therefore, we assembled an improvement team. Analysis showed the reasons for the high incidence of physical restraint events included nurses' lack of understanding and worrying about risks, agitation of patients indwelled with required tubes, lack of objective criteria for determining restraint, and deficiency of alternative restraint devices. The improvement strategies included the provision of ongoing professional education curriculum, development of a flow-chart for the restraint process and an assessment tool for high-risk restraint, and the development of “Diamond Arm＂ and communication aids as alternatives for restraints. After the implementation, the incidence of restraints decreased from 4.04% to 0.76%, showing 81.18% of improvement, without any case of inadvertent removal of indwelling tube or fall, suggesting favorable program outcome. We hoped to spread our experiences to other units and further improve the quality of care in the intensive care units.