降低骨科病房跌倒發生率之改善專案

Reducing the Incidence of Falls in Orthopedic Wards

10.6142/VGHN.202106_38(2).0003

許秀珠(Hsiu-Chu Hsu)；曲幗敏(Kuo-Min Chu)；簡鈺亭(Yu-Ting Jian)；董昕宜(Sin-Yi Dong)；周舒媛(Shu-Yuan Chou)

跌倒 ； 骨科病人 ； falling ； orthopedic patient

榮總護理

38卷2期（2021 / 06 / 01）

133 - 142

繁體中文

跌倒是醫療照護品質之重要指標，不僅增加骨科病人再次骨折的風險，影響病人術後恢復與生活品質，同時反應照護品質，護理人員工作士氣亦受影響。本單位於2018年跌倒發生率高達0.11%，分析原因有：病人、主要照顧者及護理師預防跌倒認知不足、評估篩選表無法正確篩檢高危險群、缺乏麻醉術後預防跌倒之衛教單張、護理師未落實防跌措施。改善措施包括：訂定高危險跌倒病人分級制度、製作下肢復健運動影片、執行麻醉術後防跌護理指導、製作跌倒資訊看板及走廊字幕顯示器增加防跌警語、跌倒案例討論、舉辦在職教育以及執行防跌措施之稽核等。經專案改善後，2019年跌倒發生率由0.11%降至0.04%，顯示本專案成效；期望專案小組分享骨科病人跌倒之風險及改善方案，提升病人、主要照顧者防跌的認知及護理師對防跌措施的落實，以供同儕參考。

Patient falls are an important indicator of the quality of care that not only increase the risk of refracture among patients in orthopedic care but also affects the patient's postoperative recovery and quality of life. Patient falls can also reduce the morale of nursing staff. The mean incidence of falls in our unit was 0.11% in 2018, significantly higher than the threshold. According to our analysis, the causes of falls are as follows: first, a lack of awareness of fall prevention measures, weakness in the lower limbs after the operation, and dizziness; nonetheless, patients still tend to think that they could go to the toilet without assistance. Furthermore, main caregivers also lacked awareness of fall prevention measures and did not accompany the patient at all times when assisting the patient in getting out of bed or going to the toilet. Additionally, the assessment form that was used could not correctly screen for high-risk groups, and insufficient health education guidance for fall prevention after anesthesia was provided. Therefore, a project team was organized in January 2019 with the aim of reducing the ward unit's fall rate. The improvement strategies included the following: first, formulating a grading system for patients with high risk for falls to identify groups that are at high risk for orthopedic falls; second, formulating health education manuals and postoperative health education leaflets to promote and strengthen fall prevention through health education; and third, creating an audit system to implement fall prevention measures. Through these strategies, the average fall rate decreased from 0.11% to 0.04%, and the project successfully achieved its objectives. By increasing the awareness of fall prevention among nurses, fall prevention has become a core value, thereby not only improving the quality of nursing care but also enhancing the morale of the nurses.

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