全膝關節置換術後病人延遲下床活動之改善專案

Out-of-bed activities improvement project for patients with TKR

10.6692/KJN.201812_35(3).0004

黃靜怡(Yi-Ching Huang)；李怡珍(Yi-Chen Lee)

全膝關節置換術 ； 下床活動 ； 早期復健計畫 ； Total knee replacement surgery ； out-of-bed activities ； earlier rehabilitation program

高雄護理雜誌

35卷3期（2018 / 12 / 01）

37 - 47

繁體中文

本專案的目的在於增強全膝關節置換術後病人的肌力，以改善延遲下床活動比率，減少住院天數。由於全膝關節置換術病人下床肌力強度不足，病人於術後第三天仍無法下床活動持續行走3公尺以上，導致延遲出院，引發本專案改善動機。經團隊運用決策矩陣提出解決辦法：1.修訂全膝關節置換術後照護衛教單、2.制定全膝關節置換術後早期復健計畫標準作業流程、3.舉辦全膝關節置換術後下床活動在職訓練、4.製作全膝關節置換術後早期復健衛教影片、5.調整輔具設定量、6.與輔助中心協調輔具租借方式。實施後病人可於術後第三天下床活動步行3公尺，延遲下床活動率由73.3%下降至9.4%。

This project aimed to improve muscle strength for patients with Total Knee Replacement (TKR) surgery and subsequently to decrease the percentage of patient's time on bed and hospital days. Seeing that weakness in the legs of patients with TKR who were not capable of walking three meters straight from the bed even on the third day after surgery caused discharge delay, this project was triggered to improve this problem. Based on our team's decision matrix, we addressed some solutions: firstly, work on amendment of TKR healthcare leaflets; secondly, stipulate SOP of TKR earlier rehabilitation program; thirdly, organize out-of-bed training activities; fourthly, make films for presenting TKR earlier rehabilitation program; fifthly, adjust the permissible level of using mobility devices; and sixthly, coordinate the rental service with mobility device center. As a result, after implementing the project solutions, patients were capable of walking three meters straight on the third day after TKR surgery and the delay in patient's movement out of bed decreased substantially from 73.3% to 9.4%.