運用醫療團隊資源管理改善身體約束品質之專案

Utilizing Team Resource Management to Improve the Quality of Physical Restraint

10.6847/TJPMHN.201806_13(1).05

謝玉萍(Yu-Ping Hsieh)；林青蓉(Lin Ching Rong)；康美琦(Kang Mei-Chi)；吳志卿(Wu Chin-Ching)；邱淑娟(Chiou Shu-Jiuan)

醫療團隊資源管理 ； 身體約束 ； team resource management ； physical restraint

精神衛生護理雜誌

13卷1期（2018 / 06 / 01）

35 - 43

繁體中文

身體約束是精神科處理暴力常見重要處置，執行不當造成生理及心理傷害，甚至引發醫療糾紛。本院2014年統計身體約束事件造成抱怨事件多達228件，正式申訴事件3件，糾紛事件1件，嚴重影響照護品質及團隊士氣。運用調查、訪談及觀察法，確立問題為：團隊約束技術正確率低、約束用物材質不良、缺乏團隊約束演練及稽核、缺乏人文關懷素養。藉由導入約束教育訓練課程、團隊身體約束演練及交叉稽核、增購及約束用物改善、舉辦身體約束體驗營。結果顯示：身體約束技術操作正確率由63%提升至95%，口頭抱怨件數由47.6%下降為15.8%，未發生申訴及糾紛事件。運用團隊合作與共識，增進處理身體約束專業技能，以正向、視病猶親方式來執行約束，提升照護安全及品質。

Physical restraint is commonly used to manage violent behaviors in psychiatric field. But improper implementation of physical restraint can result in physical or psychological harm which affects medical treatment and patients' relationship and incurs possible medical disputes. From 2014 January to December, there were four-hundred-and-eighty cases (4.9%) related to physical restraint where a-two-hundred- and-twenty-eight cases resulted in verbal complaints (47.6%), among which three cases resulted in formal appeals and one case lead to a serious dispute. It influences overall team's spirit greatly and the quality of care. To resolve this issue, ad hoc group was established to review and improve current circumstance. Based on clinical investigations, interviews, and observations, the problem identified are: a low percentage of proper techniques among team performance, a poor quality physical restraint with few selections, insufficient training time related to physical restraint, and a lack of humanistic care, and restraints are viewed as routine work. The specific improvement measures adopted include: the introduction of team resource management, education and training courses, the establishment of team physical restraint exercise and cross-audit, purchase and restraints to improve the use of physical constraints to experience the camp. The outcome showed an increase proper usage of physical restraint techniques from 63% to 95%. The verbal complaints from patient decreased from 47.6% to 15.8%. And zero cases result in formal appeal and serious dispute. Thus, the use of medical team resource management may promote teamwork and reach a consensus of opinions, enhance professional techniques in handling physical constraints among peers, learn to stay a positive attitude of mind, depend on the disease pro-way to enforce the constraints, and improve safety and quality care.

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