降低腹腔鏡手術中儀器操作異常發生率之專案

Reduced Nonfunctional Instrument Rate in Laparoscopic Surgery

手術執行的順暢，需要周邊配備與人員的配合。本單位統計2003年1月至12月本院腹腔鏡手術中，電燒儀器操作不當而致功能異常之發生率平均27.3%，這些儀器異常狀況導致手術中斷、手術時間延長和增加手術成本等不良影響。經原因分析發現主要問題有：二氧化碳鋼瓶容量小、儀器操作方式複雜、護理人員不熟悉儀器操作、沒有定期做儀器檢測及保養、沒有儀器操作手冊可供參考等。針對二氧化碳鋼瓶容量方面的問題，單位向院方提出更換容量較大的建議外；另在單位內成立一專案小組，針對護理人員操作錯誤、不熟悉等疏失問題執行改善工作。經過在職教育訓練、製作多媒體教材宣導、定期操作回覆示教、建立腹腔鏡儀器簡易操作卡及建立操作保養之標準作業規範等改善工作後，腹腔鏡手術中儀器功能異常發生率降低為1.2%，更加保障病患手術過程中的安全性。

In order for surgery to be carried out smoothly, it requires medical instruments to work in harmony with medical professionals. In this unit, from January to December 2003, there was a 27.3% nonfunctional instrument rate, which led to the discontinuation of laparoscopic procedures. This unusual situation not only caused surgery to be discontinued but also increased surgery time and subsequent costs. After performing cause analysis, we found that the capacity of the carbon dioxide steel cylinder was insufficient, the nursing staff were unfamiliar with the instrument's operation, instrument examination and maintenance were not performed regularly, and no instrument operating manual was available for reference purposes. In light of the insufficiency of the carbon dioxide steel cylinder capacity, we enlarged its capacity. In view of the nursing staff situation, improvement work was undertaken, including in-service education and training, use of multimedia teaching material and regular demonstrations, use of operation note cards, and improvement in the standard of maintenance work. After the improvement project, the nonfunctional instrument rate during laparoscopic procedures was reduced to 1.2%. This result will lead to an improvement in quality of care and patient safety.