提升腰椎滑脫病人術後24小時內下床達成率

Improving the Ambulation Rate Within 24 Hours Post-Surgery for Patients With Lumbar Spondylolisthesis

背景國人於日常生活中彎腰動作增加或外傷，導致腰痛及活動力下降，是腰椎手術主因。腰椎手術後病人於24小時內下床活動，可避免長期臥床導致的生理不良反應，及提升病人下床意願，避免延長住院天數。專案期間調查腰椎滑脫病人術後24小時內下床達成率僅15.2%，分析原因為：病人擔心下床時引流管會滑脫、護理人員衛教內容不一致，未說明下床時機、無腰椎滑脫下床標準流程、病人不清楚下床時機及重要性。
目的提升腰椎滑脫病人術後24小時內下床達成率，進一步增加下床步驟正確性及護理人員衛教完整性。
解決方案設計「Hemovac掛繩」及「走出迷之宮」、製作「下床活動拼樂趣」及「腰椎手術術後下床知多少？」衛教影片、制訂「腰椎滑脫術後下床活動標準流程暨教育訓練」。
結果腰椎滑脫病人術後24小時內下床達成率由15.2%提升至95.0%。
結論病人及照顧者能了解早期下床重要性及下床步驟正確性，以利恢復日常活動功能，而護理人員有效提升護理指導完整性，使病人獲得完整及高品質之整體性照護。

Background & Problems: Frequent bending movements and injuries in daily life often result in back pain and reduced mobility, making these primary reasons for lumbar spine surgery. Mobilizing patients within 24 hours after lumbar spine surgery is known to help prevent the adverse physiological effects of prolonged bed rest, enhance willingness to mobilize, and minimize the duration of hospitalization. However, a survey in our hospital indicated the achievement rate of mobilization within 24 hours postoperatively in patients with lumbar spondylolisthesis was only 15.2%. The primary reasons for this low rate were identified as patient concerns about drain dislodgement during mobilization, inconsistent health education from nursing staff, lack of explanation about mobilization timing, absence of a standardized mobilization protocol for lumbar spondylolisthesis, and inadequate patient understanding of the timing and importance of mobilization.
Purposes: The project addressed in this study was developed to improve the achievement rate of mobilization within 24 hours postoperatively in patients with lumbar spondylolisthesis and to enhance the accuracy of mobilization steps and completeness of related education for nursing staff.
Resolution: The“Hemovac Strap”and“Escape the Maze”were developed; a“Mobilization Fun Puzzle”was created; an educational video entitled“How Much Do You Know About Post-Lumbar Surgery Mobilization?”was produced; and the“Standardized Postoperative Mobilization Protocol and Training for Lumbar Spondylolisthesis”handbook was implemented.
Results: The mobilization achievement rate within 24 hours postoperatively in patients with lumbar spondylolisthesis increased from 15.2% to 95.0%.
Conclusions: Patients and their caregivers gained a better understanding of the importance of early mobilization and the correct mobilization steps, facilitating the recovery of daily functional activities. Nursing staff significantly improved the comprehensiveness of educational guidance, enabling patients to receive holistic and high-quality care.