以品管圈手法提升全膝關節置換術後膝屈曲角度達成率

Use of the Quality Control Circle to Increase the Percentage of Patients Reaching 90 Degrees in Knee Flexion after Total Knee Joint Replacement

全膝關節置換術後首要目標，為膝關節屈曲角度達90度，進而恢復日常生活活動。臨床發現術後病人因疼痛，未落實執行復健運動，術後膝關節屈曲90度達成效果不如預期，至術後第五天達成僅41.9%，引發本改善動機，經實際調查發現達成率低主因有:不了解如何復健、動作記不起來、管路太多怕拉扯、缺乏監測機制、不會教做法不一致、衛教單圖示不明確。介入措施改善方法為製作口訣教學影片、將動作製成圖像衛教單張、設計口訣海報製作、製作簡易管路固定袋、創新膝關節角度測量器、舉辦專科在職教育課、制定一致作業標準與評核機制。實施後病人術後第五天膝關節屈曲90度達成率由41.9%提升至100%，具顯著成效，期提供臨床照護上之參考。

For patients who have undergone total knee joint replacement, the primary goal is to reach a knee flexion of 90˚and resume their activities of daily living. Clinical findings indicated that the patients could not fully implement postsurgical rehabilitation exercises because of pain and, consequently, the percentage of patients reaching postsurgical 90-degree knee joint flexion was lower than expectation; on Day 5 after the surgery, the percentage of patients with a knee flexion of 90˚was only 41.9%. This study was thus inspired to improve the postsurgical rehabilitation effectiveness. Empirical results indicated that the low percentage of the patients reaching desired knee flexion was mainly caused by the following factors: insufficient understanding of how to rehabilitate, inability in memorizing rehabilitative moves, fear of pulling the many tubes attached on their bodies , lack of a monitoring mechanism, inconsistent teaching methods, and unclear instructions on the health education flyers. The improvement methods of intervention measures are to make a formula teaching video, turn the action into an image health education leaflet, design a formula poster, make a simple tube fixing bag, innovate a knee joint angle measurer, conduct specialist courses education class, and formulate a consistent operating standards and evaluation mechanism. After the improvement methods, the rate of achieving 90˚of knee flexion increased from 41.9% to 100% on the fifth day after the operation, with remarkable results, which is expected to provide a reference for clinical care.