推廣橈動脈心導管手術穿剌處塗抹麻醉劑

Promoting the Use of Skin Surface Anesthetic to the Puncture Site of Radial Artery in Cardiac Catheterization

本改善專案旨在提升橈動脈心導管手術穿剌處塗抹麻醉劑北痛措施之完整性，以有效減輕病人的疼痛感受。經調查接受心導管患者術後穿剌處疼痛評估NRS得分總平均7.94分，經查顯示塗抹麻醉劑執行過程不完整，完整率僅25.0%。專案小經確立問題及要因分析後，擬定及執行改善方案，包括建立塗抹麻醉劑照護常規、建立表皮用局部麻醉劑正確塗抹標準步驟圖示及標準、製定塗抹麻醉劑時間紀錄表及規範、修訂心導管術臨床路徑及術前多媒體衛教內容、舉辦臨床人員在職教育訓練、針對作業流程安排跨科室護討論會、制定品管監測計劃，並定監測等措施，結果橈動脈心導管手術穿刺處涂抹麻醉劑止痛措施之完整率由25%提升至96.9%，病人心導管穿刺處疼痛評估量表平均得分也由7.94分降低至2.01分，顯示正確執行穿刺部位涂抹麻醉劑止痛措施，可有效降低患者於心導管手術穿刺部位之疼痛。

Traditional cardiac catheterization is through the way that we insert in patient's groin; however, this may lead to some complications such as hematoma and hemorrhage. In order to decrease the possibility of complications, it's more widespread that we conduct the surgery through radial artery. The shortcomings are that the surgery is time-consuming, and the punctual wound may cause stabbing pains. To improve this phenomenon, we will apply skin surface anesthetic to the body parts before the surgery. By inquiring into the patients, it shows that the average Numerical Rating Scale 7.94 points indicates that the process we apply the skin surface anesthetic to the body parts is not rigorous enough, which shows the appliance is 25%. The ad hoc group analyzed the reasons of the problem, and drew up and implement the plans to improve the situation, which include: (1)establishing the medical guideline, (2)establishing the standard operation process of applying the skin surface anesthetic; and formulating the quality improvement schedule, and then monitoring the outcome, (3)holding interdepartment conferences discussing the standard operation process, (4)adding a sheet of applying the skin surface anesthetic and a checklist, (5)revising cardiac catheterization clinical passway and pre-operative multimedia education program, (6)holding lectures for clinical staff. After the staff follow the guidelines, the appliance rate from 25% to 96.9%, and the average Numerical Rating Scale decreased from 7.94 point to 2.01 point, which indicated that applying the skin surface anesthetic can alleviate the pain of the cardiac catheterization.