以改良替代式約束手套降低病人身體約束事件發生率

Reducing the Ratio of Patients with Physical Restraint using a Modified Restraint Glove

背景：身體約束通常用於維護病人安全及降低非預期自拔醫療管路，然而，不當的身體約束，反而會增加病人身心層面上產生皮膚壓瘡、肢體水腫、躁動不安、混亂及憂鬱。台灣臨床指標（Taiwan Clinical Performance Indicator，簡稱TCPI）將身體約束的使用及發生率視為重要的醫療品質指標，根據資料統計本單位於2016年住院人日數中，共有18,380位病人，其中185人發生身體約束，發生率為1%，而身體約束事件為全院之冠。目的：本專案旨為降低單位高約束事件發生率。方法：經現況分析發現其原因為：（一）擔心病人自拔管路；（二）醫護團隊認知不一；（三）替代式約束手套設計設不良。提出對策措施為：1.增加約束護理相關教育；2.管路固定妥當；3.交班時再次評估是否有約束必要性；4.發展替代式約束工具。結果：在專案實施後三個月，約束發生率由190下降到0.26％，已達本專案之目標。結論：實務應用臨床上面對約束之個案，可使用新式約束手套，替代傳統約束手套。規劃身體約束指引及課程，增進團隊對約束共識，以降低身體約束事件發生，提升醫療照護品質。 Background: Improper use of physical restraints, used to ensure patient safety and prevent accidents, is associated with an increased risk of pressure sores, extremity oedema, agitation, confusion and depression. The Taiwan Clinical Performance Indicator considers the use and incidence of physical restraints as important indicators of medical care quality. Statistically, 18,380 patients were admitted to the general ward in 2016, of which 185 were physically restrained. The physical restraint rate was 1%, exceeding that of all other hospital units. Objective: This study aimed to determine strategies to reduce the physical restraint use rate. Method: As per an analysis, reasons for high rate of restraint use were as follows: (1) patients with disturbed consciousness, (2) the medical team's different cognition on restraints and (3) faulty equipment. The strategies implemented included a properly fixed medical tube, reconfirming restraint necessity during nursing endorsements according to guidelines, in-service education, experiencing being restrained and developing a modified restraint glove. Result: The patient's physical restraint rate reduced from 1% to 0.26% in three months. Conclusion: The modified restraint glove promotes patient safety and comfort, and the nursing administration can plan a course on reduced physical restraint use to improve the quality of medical care.