運用多元策略降低內科加護病房身體約束發生率

Multiple Strategies to Reduce the Incidence of Physical Restraint in a Medical Intensive Care Unit

身體約束在重症單位常被運用於維護患者安全，但其使用可能導致病人身體及心理之嚴重傷害。統計本單位2020年1月至2020年12月，身體約束事件發生率為15.8%，超乎醫學中心身體約束事件發生率目標閾值10%，故本專案皆為降低身體約束事件發生率，專案小組採用多元策略舉辦約束在職教育課程、修訂約束護理標準與稽核、並創意發想約束替代輔具，專案在執行1年後身體約束事件發生率，由原先15.8%下降至9.6%。期間亦無不當身體約束造成的異常事件及管路自拔，單位逐步建置無約束的環境，落實以病人為中心的價值，朝向零約束照護環境邁進。

Physical restraints are often used in intensive care units to ensure patient safety, but their use may cause physical and psychological harms to patients. Between January and December 2020, the rate of physical restraint use in our unit was 15.82%, exceeded the medical center’s target threshold of 10%. Therefore, this project was undertaken to reduce the rate of physical restraint use in our unit. The task force adopted the multiple following strategies: provision of on-the-job restraint education courses, revision of nursing standards and audits for physical restraints, and development of alternative assistive devices to physical restraints. A year after the implementation of the project, the rate of physical restraint uses from 15.8% decreased to 9.6%. No unusual incident involving improper use of physical restraints or self-extraction of restraints occurred during the project period. The unit gradually developed a restraint-free environment, adopted patient-centered values, and progressed toward a zero-restraint care setting.