提升某加護病房護理師執行口腔癌術後游離皮瓣評估一致性

To improve nurses' consistency of free flap assessment after oral cancer surgeries in a surgical intensive care unit

曾莉淳(Li-Chun Tseng) ； 陳冠宇(Guan-Yu Chen) ； 洪舒育(Shu-Yu Hung) ； 林琪馨(Chi-Hsin Lin)

《彰化護理》 29卷3期 (2022/09) Pp. 58-70

https://doi.org/10.6647/CN.202209_29(3).0009

摘要

本專案目的為提升某外科加護病房護理師執行口腔癌術後游離皮瓣評估一致性，專案動機：護理師執行皮瓣評估一致性僅達63.7%，知能達83.0%。加上未能及時發現皮瓣異常導致病人需再次重建。問題確立：護理師認知不一致、評估游離皮瓣過程不一致、在職教育出席率低、無示範教學、無定期稽核、評估儀器及設備不足。解決辦法：開立游離皮瓣共識會議、運用智慧型手機拍照紀錄、辦理在職教育課程床邊示範教學、添購監測儀器並制定照護稽核辦法。實施結果：護理師執行皮瓣評估一致性由63.7%提升至96.4%，知能面也提升至98.4%。因此提升術後游離皮瓣評估的一致性，有助於降低游離皮瓣異常發生，提升照護品質及游離皮瓣存活率，降低住院天數及醫療成本。

關鍵字

游離皮瓣 ； 一致性 ； 認知正確率

並列摘要

The aim of this project is to improve nurses' consistency of free flap assessment after oral cancer surgeries in a surgical intensive care unit. Motivation: Nursing knowledge about free flap monitoring reached 83.0%, meanwhile the consistency of free flap assessment was only 63.7%. Delays in identifying abnormal changes of the flap often lead to a second surgery. Identify problems: inconsistent cognition; inconsistent free flap assessment; low attendance rate of in-service training; lack of demonstration; no regular audits; insufficient monitoring equipment. Solutions: setting up consensus meetings for free flap assessment; utilizing smartphones to take photos; conducting in-service training and skill demonstration; purchasing monitoring equipment; formulating free flap monitoring guidelines. Results: Nurses' consistency of free flap assessment rose from 63.7% to 96.4%, and the knowledge ability increased to 98.4%. Improving the consistency of postoperative free flap assessment helped reduce the occurrence of abnormal free flaps, length of hospital stay, and medical costs, and enhance the quality of care and survival rate of the free flap.

並列關鍵字

Free Flap ； consistency ； cognition accuracy

參考文獻

蔡麗珍(2017)‧提升護理臨床教師直接觀察操作型技術評量法(DOPS)應用之教學研究‧領導護理，18(1)，59-69。https://doi.org/10.29494/LN.2017_18(1).0006

Chao, A. H., & Lamp, S. (2014). Current approaches to free flap monitoring. Plastic Surgical Nursing, 34(2), 52-56. https://doi.org/ 10.1097/PSN.0000000000000037

Han, Z. F., Guo, L. L., Liu, L. B., Li, Q., Zhou, J., Wei, A. Z., & Guo, P. F. (2016). A comparison of the Cook-Swartz Doppler with conventional clinical methods for free flap monitoring: a systematic review and a meta-analysis. International Journal of Surgery, 32, 109-115. https://doi.org/10.1016/j.ijsu.2016.06.034

Kohlert, S., Quimby, A., Saman, M., & Ducic, Y. (2019). Post operative free-flap monitoring techniques. In Seminars in plastic surgery, 33 (1),13-16. https://doi.org/10.1055/s-0039-1677880

Patel, U. A., Hernandez, D., Shnayder, Y., Wax, M. K., Hanasono, M. M., Hornig, J., Ghanem, T. A., Old, M., Jackson, R. S., Ledgerwood, L. G., Pipkorn, P., Lin, L., Ong, A., Greene, J.B., Bekeny, J., Yiu, Y., Noureldine, S., Li, D. X., Fontanarosa, J., ... Richmon, J. D. (2017). Free Flap Reconstruction Monitoring Techniques and Frequency in the Era of Restricted Resident Work Hours. JAMA Otolaryngology– Head & Neck Surgery, 143(8), 803-809. https://doi.org/10.1001/ ja- maoto.2017.030410.1001/jamaoto.2017.0304