提升外科加護病房「腹部手術病人肺部復健運動」執行率

To Improve the Implementation Rate of Pulmonary Rehabilitation Exercises in Post-abdominal Surgery Patients in the Surgical Intensive Care Unit

腹部手術病人常因傷口疼痛、疲倦導致活動減少，使肺容積下降，將影響氣體交換引起肺部合併症，再次重返加護病房，而造成延長住院天數。經調查單位腹部手術病人肺部復健運動執行率僅44.0%，故引發改善動機，經分析發現：主要原因為缺乏腹部手術病人肺部復健運動作業標準與評值工具以及病人因傷口痛、疲倦或未被衛教及護理人員缺乏肺部復健運動教育訓練等因素。於2019年4月至8月專案改善期間，透過建立腹部手術病人肺部復健運動作業標準、制定評值工具、製作衛教隨手版及舉辦在職教育等改善策略。實施後，腹部手術病人執行肺部復健運動執行率由44.0%提升至93.3%；護理人員對「腹部手術病人肺部復健運動」認知提升為100%。除此之外，專案執行後，病人並無因肺部呼吸問題而重返加護病房，由此可知，腹部手術病人早期於加護單位執行肺部復健，可降低重返加護病房的機會，以及提升重症病人的臨床照護品質。

Post-abdominal surgery patients often suffer from lung complications due to pain, fatigue, and the consequential reduced activity, which decreases lung volume and affects gas exchange, resulting in readmission to the ICU and prolonged hospital stay. This project aimed to improve the implementation rate of pulmonary rehabilitation exercises in post-abdominal surgery patients in the surgical intensive care unit. The survey showed that the current implementation rate of pulmonary rehabilitation exercises was only 44.0%, which was attributed to the lack of post-abdominal surgery pulmonary rehabilitation exercise standards and implementation of assessment tools, and also because patients did not know what exercises to do. During the project improvement period from April to August 2019, the pulmonary rehabilitation exercise performance standards for post-abdominal surgery patients, the health education handbook, and the patient exercise rating tool had been established and effectively applied. After the completion of the program, the implementation rate of pulmonary rehabilitation exercises for post-abdominal surgery patients increased from 44.0% to 93.3%. The awareness of pulmonary rehabilitation exercises in nursing personnel increased to 100%, which achieved the goal of the program and indicated that the program was worthy of dissemination. The post-op pulmonary rehabilitation for patients undergoing abdominal surgery enhanced the quality of nursing care through this project.