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1 64 Repositioning 提升護理人員翻身擺位執行之正確率楊禮謙陳明惠 * 曾瓊瑩 ** 張倩瑜 *** 曾怡萍 *** 莊玟玲 **** 由於本單位的入院後壓瘡率有逐月升高的情形, 現況分析後發現護理人員執行翻身擺位的正確與否影響壓瘡的發生, 經臨床監測護理人員的執行翻身擺位, 正確率平均只達 12% 進而探討導致翻身擺位執行不正確的因素有 :⑴ 護理標準欠完善 ;⑵ 缺乏翻身擺位的教育訓練 ;⑶ 未進行翻身擺位技術執行的控管 ;⑷ 護理人員缺乏實際的演練, 不熟練翻身擺位程序 ;⑸ 翻身輔具不良 ;⑹ 翻身輔具數量不足 ;⑺ 防壓輔具使用不當 ;⑻ 壓瘡發生率未列入單位之品管控制經由文獻查證並與小組討論後, 擬定下列措施進行改善 : ㈠制訂詳細的翻身擺位程序標準技術 ; ㈡加強在職教育宣導訓練 ; ㈢增添翻身輔具枕頭與水枕 ; 以及㈣檢討壓瘡率, 進行案例分析經由以上執行措施後, 翻身擺位執行正確率由 12% 提升為 88%, 壓瘡率也由 0.47% 降低為 0.05%, 由此發現護理人員翻身擺位執行之正確率可能會影響壓瘡的發生率, 因此期望藉由本專案提供給相關照護單位參考, 共同提升病患之照護品質壓瘡翻身擺位 Gordon, Gottschlich, Helvig, Marvin, & Richard, 2004 Frantz, 2004 Maklebust, 2004 Hill, 1992 Mazzocco & Zampieron, 2000 Bostrom & Kenneth, % 0.17% % % 6 2, % 10 2, % 10 2, % 0.13% * ** *** ****

2 65 < 30 < % 35% 30% ㈠㈡ % 20 50%

3 66 Repositioning ㈢ % ㈣㈤ 50% n = 122 ㈥ 32 80% ( 總床數 ) 90%( 佔床率 ) 2( 每床病患及家屬各一個枕頭 )= 122( 基本需求量 ) (25 平均臥床患者數 2 個枕頭, 背與腳各一個 )= 172( 實際需求量 ) ( 原病房數量 )+ (25 平均臥床患者數 4 個水枕 )= 100( 實際需求量 ) ㈦㈧

4 % 80% 50% Moody, % Maklebust, 1997 Maklebust, 1997 Hill, 1992 Frantz, 2004; Maklebust, Maklebust, Eaton-Bancroft, Maklebust, 2004agency for health care policy and research, AHCPR Registered Nurses Association of Ontario, ㈠ 3 ㈡㈢ ml

5 68 Repositioning /

6 ㈠㈡㈢㈣㈤ % 88% 0.47% 0.05% 1993 Mazzocco & Zampieron, 2000 Weienke, 1987 Hill, 1992

7 70 Repositioning Hill, ml % 10 2, % 1 2,131 Evidence Base Nursing Bostrom, J., & Kenneth, H. (1992). Staff nurse knowledge and perceptions about prevention of pressure sores. Dermatology Nursing, 4(5), Eaton-Bancroft, I. (2005). Teaming up for wound care. Nursing, 35(4), 32hn1 32hn3. Frantz, R. A. (2004). Decubiti prevention and treatment. Techniques in Orthopaedics, 19(3), Gordon, M. D., Gottschlich, M. M., Helvig, E. I., Marvin, J. A., & Richard, R. L. (2004). Review of evidenced-based practice for the prevention of pressure sores in burn patients. Journal of Burn Care & Rehabilitation, 25(5), Hill, L. (1992). Wound care nursing. The question of pressure. Nursing Times, 88(12), Maklebust, J. (1997). Pressure ulcers: Decreasing the risk for older adults. Geriatric Nursing, 18(6), Maklebust, J. (2004). Take the load off by choosing the right support surface. Nursing, 34, Mazzocco, R., & Zampieron, A. (2000). Does the evaluation of the pressure ulcer risk increase better prevention? Professioni Infermieristiche, 53(3), Moody, M. (1997). Fighting against pressure sores and a rise in legal suits. British Journal of Health Care Management, 3(1), Registered Nurses Association of Ontario (2005). Risk assessment and prevention of pressure ulcers. Toronto, Canada: Author. Weienke, V. K. (1987). Pressure sores prevention is the challenge. Orthopaedic Nursing, 6(4),

8 71 Elevating the Accuracy Rate for Nurses Changes of Patients Positions Li-Chien Yang Ming-Hui Chen * Chiung-Ying Tseng ** Qian-Yu Zhang *** Yi-Ping Zeng *** Wen-Ling Chuang **** Abstract: The incidence of pressure sores among inpatients had increased in our ward month by month. Clinical checklists and data analysis showed that the accuracy rate for nurses changes of patients positions was 12%. The investigation of reasons for this low accuracy rate included: (1) A flawed nursing standard for position changes. (2) Lack of training for position changing. (3) Lack of quality management and control of position changes. (4) Lack of practice and unfamiliarity with the procedures for position changing. (5) Poor quality of pressure-reducing surfaces. (6) Shortage of pressure-reducing surfaces. (7) Inappropriate method of use of pressure-reducing surfaces. (8) Non-inclusion by management of incidence of pressure sores within the scope of quality control. After a review of literature and group discussion, strategies were adopted to: (1) Establish a detailed explanation of standards for position changes. (2) Arrange lectures and promotional campaigns. (3) Add more pillows and water cushions. (4) Conduct case analysis when a patient develops a new pressure sore. After completion of this project, the accuracy rate for nurses changes of patients positions increased from 12% to 88%, and the incidence of pressure sores decreased from 0.47% to 0.05%. The result shows that accuracy of position change may affect the rate of pressure sore. We expect this project to serve as a reference in clinical practice for promotion of the quality of patient care. Key Words: pressure sore, change position. RN, BSN, Assistant Head Nurse, Department of Nursing, Chi Mei Medical Center; *RN, MSN, Diabetes Educator; **RN, BSN, Head Nurse; ***RN, BSN; ****RN, MSN, Wound Care Specialist. Received: December 14, 2006 Revised: March 16, 2007 Accepted: July 26, 2007 Address correspondence to: Wen-Ling Chuang, No. 901, Chung Hwa Rd., Yung-Kung City, Tainan 71004, Taiwan, ROC. Tel: 886(6) ext ; @mail.chimei.org.tw

7_6論文.indd

7_6論文.indd 一黃春滿董道興 * 師慧娟 ** 中文摘要本篇個案報告是探討一術後病的, 期間為 94 年 4 月 28 日至 5 月 13 日筆藉由 Gordon 十一項健康功能評估為工具, 運用身體評估觀察及會談的方式收集資料, 在期間發現個案出現體溫過高焦慮疼痛

65 < 30 < % 35% 30% ㈠ ㈡ % 20 50%

65 < 30 < % 35% 30% ㈠㈡ % 20 50%