異體手移植手術提供手臂缺損病人新希望,在接受手術後,能重建肢體外觀,運動能力的恢復以及感知功能的復原,如溫度、觸覺等,讓生活品質大大改善。目前台灣已完成三例異體手移植手術,手術為複雜性高且跨科團隊進行,由於手術案例少,因此人員對此項新手術方式認識有限且流程不熟悉,也無標準作業供參考,所以人員在面對異體手移植手術時,倍感壓力亦產生極大挫折感。經調查發現人員在異體手移植手術準備正確率僅達42.3%,異體手移植手術準備正確率認知不足僅達58.5%,故引發此專案改善動機,希望透過專案手法,讓同仁在面對此尖端新移植手術時,能快速進入狀況,提升手術準備正確率,以維護手術病人安全。於2016年4月16日至2017年9月30日專案改善期間,建立手臂手術準備材料行動車、製作組織標示牌、舉辦保冰袋技能及異體手移植手術準備工作坊、舉辦在職教育、制定異體手移植手術標準作業規範。經實施後結果:人員對於手術準備正確率由42.3%提高至98.5%;手術準備認知正確率由58.5%提升為99.3%,達到專案目的。顯示建構異體手移植手術準備流程對提升異體手移植手術準備正確性有正面意義,期望可以推廣到全台有在進行移植手術的醫院,讓更多護理人員知道此項手術的發展,提升醫療照護品質。
The allotransplant surgery of hand could provide the hope, not only the appearance, motor function, and sensory recovery such as temperature and touching sensation, but also the tremendous improvement of quality of life after surgery. Currently, three successful cases were performed in Taiwan. The surgery itself is highly sophisticated with multi discipline team collaboration. The staff and member may feel stressful and under high pressure due to lack of experience such as limited case number. In addition, the unfamiliarity of the logistic and preparation process also contributes to the distress. By further investigation the accuracy of preparation process was just 42.3%. The accuracy of knowledge for preparation was merely 58.5%. Therefore, here we advocate a special topic for promoting this project in order to increase the accuracy of preparation process and get quick response when facing allotransplant surgery. The improvement project was implemented from September 2016 to April 2017. These implementations included the material preparing mobile car, special marking signs of specific tissue, training camp for ice bag skills, workshop for allotransplant surgery preparation process, continued medical education, and setup of the standard operative procedure (SOP) during the surgery. The result showed the accuracy of preparation process improved from 42.3% up to 98.5%. The accuracy of knowledge for preparation improved from 58.5% up to 99.3%, reaching the goal of this special project. In conclusion, the construction of a hand allotransplant surgery preparation process yields a promising result. By this method, we hope it could be advocated to other hospital under the processing of allotransplant hand surgery for improving the quality of medical care in the nursing staff.