降低骨科術後護理活動及指導缺失率改善專案

Reducing the Nursing Educational Activities and Instruction Miss-Rate with Post-Orthopedic Surgery Patients

骨科病患術後減除疼痛、增加患肢活動度及力量，以早日恢復正常作習，臨床上護理衛教及指導介入，提供病患、家屬正確照護資訊，護理品質及病人滿意度都會大幅提昇，故引發此專案動機。單位於95年8月31日~95年9月14日實地查核20位骨科手術術後護理活動及指導其缺失率為27.3﹪，利用80/20原則其中以復健護理指導、教導患肢傷口護理指導不完整和疼痛評估不確實三項為改善重點，其對策包括制訂復健衛教、骨科術後患肢照護的注意事項的衛教單張及海報，統一衛教時間及方法，增訂的疼痛評估量表、評估時間及落實執行。經本由專案實施後缺失率，由改善前27.31﹪降至改善後5.46﹪，效果維持目標值5.5%以下，執行效果良好，將骨科術後照護流程及細則標準化，讓護理人員依循此標準執行，提昇照護品質。

After surgery, orthopedic patients expect pain relief and are concerned with increased mobility and the strength of their affected limb; they wish to quickly recover and go back to their normal routine. Clinical intervention in the form of nursing educational activities and instruction, so that patient and relatives obtain accurate information on nursing care, substantially increases nursing quality and patient satisfaction. The desire to improve nursing educational activities and instruction is the motivation for this study. In the period from August 31 to September 14, 2006, after clinical observation of nursing educational activity and instruction involving twenty post-orthopedic surgery patients, we found that there was a miss-rate of 27.31%. Based on the 80/20 principle, we found that the three main problems that require improvement were incomplete nursing instruction about rehabilitation, incomplete nursing instruction about wounds and inaccurate pain assessment. In order to improve this situation, the strategies identified as needing to be adopted included: 1) the production of educational leaflets and posters on rehabilitation and post-surgery limb care; 2) the creation of specific times and methods of education across all persons involved and 3) a revised and improved pain assessment scale. Once these strategies were adopted, the missrate decreased from 27.31% to 5.46%. The miss-rate target value had been set at 5.5% and therefore our intervention was highly successful and should be integrated into the regular nursing system in order to enhance the quality of orthopedic care.