兒科病房住院病童之跌倒改善專案

Fall Reduction in the Pediatric Unit

10.6530/YYN.2012.6(2).06

謝秀玲(Hsiu-Ling Hsieh)；侯惠珍(Hui-Chen Ho)；鄭涵菁(Han-Chin Cheng)；楊美紅(Meei-Horng Yang)

跌倒發生率 ； 傷害程度 ； 病童 ； incidence of falls ； injury level ； sick child

源遠護理

6卷2期（2012 / 11 / 01）

39 - 48

繁體中文

跌倒為本單位異常事件之首，隨著兒童的自主能力發展，加上對環境好奇，超強活動能力，安全認知的不足，往往導致病童成為跌倒之高危險群，採取有效對策才能預防跌倒事件成為當務之急。本專案成立於2008年4月，透過回溯方式統計2007年2月至2008年1月，跌倒發生率0.11％，其中、重度傷害佔66.7％。運用五大現原主義分析病童跌倒發生原因，主要照顧者及護理人員之跌倒認知訪談，結果共 項需改善之項目，透過標準作業流程再造，設置回覆示範教室，進行教育訓練及模擬測驗，提升護理人員、病童、主要照顧者的認知；經由系統性預防跌倒護理指導，改變照顧者之照護行為；以具體寫實兒童預防跌倒警示圖輔助，臨時托顧病童及相關協助資源及持續性品質監測機制辦法，有效降低住院病童跌倒率。專案執行後跌倒發生率降為0％（2008年8月），中、重度傷害由66.7％下降至0％，改善幅度為100％，效果維持（2008年9月至2011年12月）為0.01％，達到品質管控。

This report describes the process to reduce risk of falls in a pediatric unit. Children are at high risk to fall because of an increase in autonomy, curiosity, mobility and lack of safety awareness. Fall was the most frequent type of incident in our pediatric unit. From February 2007 to January 2008 data showed that the incidence of fall was 0.11% and that 66 .7% of those resulted in severe injuries. The unit's fall reduction program to investigate cause began in April 2008 with interviews of primary caregivers using the 5-Gen principles. The team concluded that there were seven areas for improvement and that they could be accomplished through reengineering of workflow. Nursing education was launched on fall prevention that included demonstration and return demonstration of preventive measurements. Preventive guidance was posted with graphs specific to children to improve care provided by caregivers. The program also developed resources for temporary sick-child sitting care. Audit results indicated that the incidence of falls was reduced to zero four months after the program was implemented and the incident rate for the subsequent 16 months was 0.01%.