縮短內科臥床病人首次下床天數之改善專案

Enhancing Initial Mobilization of Bedridden Patients

10.6142/VGHN.202006_37(2).0010

吳采錚(Tsai-Cheng Wu)；蕭雅云(Ya-Yun Hsiao)；粟妤詩(Yu-Shih Su)；廖淑櫻(Su-Ying Liao)

臥床病人 ； 首次下床 ； bedridden patient ； initial mobilization

榮總護理

37卷2期（2020 / 06 / 01）

192 - 201

繁體中文

本專案為運用多元策略縮短內科臥床病人首次下床天數之改善專案。專案小組發現許多病人住院前可以下床活動，但因生病於住院期間，甚至直至出院後皆未下床，鑒於避免因臥床而造成失能，專案小組於2018年2月1日至28日期間調查單位內此類病人首次下床時間，平均天數高達6.81天，4天內首次下床率為31.2%。自3月1日至8月31日，分析造成首次下床天數長的主要原因有六項，分別為病人肌力降低、病人下床動機不足、照顧者認為生病應多休息不下床、照顧者協助下床動機低、護理師未鼓勵下床及單位對協助臥床病人下床規範不明確，故設定4天內首次下床率目標為65%。經專案多元策略，包括阻力訓練「運動Go Go」、下床移位指導影片「下床Go Go」、張貼鼓勵下床海報及圖示卡、播放活潑下床活動鈴聲，以及推展臥床病人下床活動流程後，臥床病人首次下床時間由6.81天降為2.97天，4天內首次下床率由31.2%提升至69%。由此得知，本專案所建置的多元策略可以有效縮短內科臥床病人首次下床天數，期盼未來將此廣泛推展，以作為臨床照護之參考。

This study used multiple strategies to improve initial mobilization of bedridden patients. Interviews with families or caregivers revealed that, despite being able to ambulate freely, many patients remained bedridden since hospital admission and some even remained bedridden until discharge. Moreover, the average duration until initial mobilization was 6.8 days, and the rate of initial mobilization within 4 days was 31.2%. We identified six main causes of delayed initial mobilization, namely diseases associated with reduced muscle power, lack of motivation regarding mobilization, caregivers' belief in the necessity of considerable bed rest, lack of motivation among caregivers to assist with mobilization, failure to encourage mobilization among nurses, and indefinite guidelines for mobilization assistance. We established a goal of 65% initial mobilization within 4 days. After implementing a resistance training device (i.e., Exercise Go Go) and a tutorial film (i.e., Off the Bed Go Go), installing posters and notices, broadcasting lively ringtones to encourage mobilization, and establishing a workflow for mobilization, we observed a reduction in average duration until initial mobilization from 6.8 to 2.97 days, and the initial mobilization rate within 4 days improved from 31.2% to 69%. Therefore, the multiple strategies used in this project effectively improved the initial mobilization of bedridden patients. This study can serve as a reference for medical staff.

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