降低內科加護病房自發性骨折發生率之護理專案

A Nursing Project to Reduce the Incidence of Spontaneous Fractures in Medical Intensive Care Unit

溫千慧(Chien-Hui Wen)；溫雅蘭(Ya-Lan Wen)；鍾凱吉(Kai-Chi Chung)；林佳慧(Chia-Huei Lin)

自發性骨折高危險群 ； 翻身擺位 ； 病人安全 ； 加護病房 ； spontaneous fracture ； intensive care unit ； positioning and turning ； patient safety

志為護理-慈濟護理雜誌

16卷1期（2017 / 02 / 01）

66 - 77

繁體中文

本加護病房2012年第一季1~3月發生7例自發性骨折(千分之4.08)，較2011年第四季10~12月(2例/千分之1.0)攀升四倍，故成立專案小組。經文獻查證及實際查檢，歸納問題為：欠缺骨折高危險群病人之認知及照護知識；未正確執行骨折高危險群病人的翻身擺位；缺乏稽核制度、適當設備(骨折高危險群警示牌等)；缺乏骨折高危險群病人之照護標準作業流程。專案小組制定骨折高危險群評估紀錄單、警示牌、病人照護指導及計畫說明書；改良翻身單；修訂翻身擺位之護理技術及「骨折高危險群病人照護標準作業流程」；建立查核機制。追蹤成效顯示護理師對骨折高危險群病人之認知正確率由85.4%提升至100%；翻身擺位正確執行率由78.3%提升至98.2%；自發性骨折發生率由千分之4.08降至千分之0，顯示本專案有效降低住院病人自發性骨折發生率。

According to the report of our medical intensive care unit, 7 patients suffered from spontaneous fracture during the 1st season (January to March), 2012 (4.08 per mille), which was 4 times higher than the incidence rate of the 4^(th) season (October to December), 2011(1.0 per mille). A project team was established to determine the major causes. After literary review and incident investigation, the following problems were identified: Inadequate cognition of patients with high risk of fracture and corresponding nursing knowledge; improper execution of positioning or turning of patients with high risk of fracture; the absence of verification procedure and appropriate equipments (warning signs for patients with high risk of fracture); and the absence of standard nursing process for patients with high risk of fracture. The project team had created assessment records, warning signs, patient nursing guide and program instructions for patients with high risk of fracture; improved positioning/turning checklist; revised turning and positioning nursing skills and incorporated ＂Standard nursing process for patients with high risk of fracture＂; and implemented verification process. The follow-up on the effectiveness of the nursing implementations indicated that the cognition rate of nurses on patients with high risk of fracture increased from 85.4% to 100%; the completion rate of positioning and turning went from 78.3% to 98.2%; spontaneous fracture rate reduced from 4.08 per mille to 0 per mille (February, 2013 to March, 2015). The stats revealed that the project effectively reduced the spontaneous fracture rate of ICU patient.

1. Dean, E. R.,Scoggins, M. L.(2012).Essential elements of patient positioning: A review for the radiology nurse.Journal of Radiology Nursing,31(2),42-52.
2. Dytfeld, J.,Michalak, M.(2016).Type 2 diabetes and risk of low-energy fractures in postmenopausal women: Meta-analysis of observational studies.Aging Clinical and Experimental Research
3. Hommel, E.,Ghazi, A.,White, H.(2012).Minimal trauma fractures: Lifting The specter of misconduct by identifying risk factors and planning for prevention.Journal of the American Medical Directors Association,13(2),180-186.
4. Kane, R. S.,Goodwin, J. S.(1991).Spontaneous fractures of the long bones in nursing home patients.The American Journal of Medicine,90(2),263-266.
5. Liu, S.,Zhu, Y.,Chen, W.,Sun, T.,Cheng, J.,Zhang, Y.(2015).Risk factors for the second contralateral hip fracture in elderly patients: A systematic review and meta-analysis.Clinical Rehabilitation,29(3),285-294.
6. Martin-Hunyadi, C.,Heitz, D.,Kaltenbach, G.,Pfitzenmeyer, P.,Mourey, F.,Vogel, T.,Kuntzmann, F.(2000).Spontaneous insufficiency fractures of long bones: A prospective epidemiological survey in nursing home subjects.Archives of Gerontology and Geriatrics,31(3),207-214.
7. Wang, Y.,Hao, Y. J.,Deng, X. R.,Li, G. T.,Geng, Y.,Zhao, J.,Zhang, Z. L.(2015).Risk factors for bone mineral density changes in patients with rheumatoid arthritis and fracture risk assessment.Journal of Peking University,47(5),781-786.
8. Wong, T. C.,Wu, W. C.,Cheng, H. S.,Cheng, Y. C.,Yam, S. K.(2007).Spontaneous fractures in nursing home residents.Hong Kong Medical Journal,13(6),427-429.
9. 內政部戶政司(2015年，8月)．民國104年8月戶口統計資料分析．取自http://www.ris.gov.tw/zh_TW/latestmessage/-/asset_publisher/i42D/content/民國104年8月戶口統計資料分析
10. 林佳慧,曾雯琦,李淑燕,廖如文,蔣尚霖,蔣立琦(2013)。臨床的隱憂─住院病人之自發性骨折。護理雜誌，60(4)，93-98。
11. 洪秀娟,楊榮森,曹昭懿(2005)。台灣髖部骨折之流行病學。台灣醫學，9(1)，29-38。
12. 翁成傑,蔡悅琪,楊豎鈴,黃慧君(2010)。自發性骨折─某護理之家二病例報告。台灣老年醫學暨老年學雜誌，5(4)，287-296。