縮短直腸腹腔鏡手術前準備時間之專案

Strategies in Shortening Preoperative Preparation for Laparoscopic Colorectal Surgery

手術前準備時間太長將增加病人手術危險性，故進行縮短直腸腹腔鏡手術前準備時間之改善。現況調查發現：直腸腹腔鏡手術前準備時間平均55分，造成原因：手術室護理人員對手術前準備正確性認知偏低為72.9﹪；截石臥位無專用腳架及專用固定帶；儀器設備及材料類過多未整合；操作手冊內容陳舊無法即時參考；未舉辦在職教育及未設定直腸腹腔鏡手術標準監控作業。經介入教育訓練課程、整合並新增腹腔鏡手術器械、儀器及設備，修訂腹腔鏡操作參閱手冊，建立標準監控作業。改善後手術前準備時間平均25分，達到改善目的，減少手術前準備時間，降低病人手術風險，提升手術醫療服務品質使手術病人得到高品質的照護。

Since prolonged preoperative preparation for laparoscopic colorectal surgery significantly increases operative risk, this study aimed at investigating the causes of prolonged preparation and the appropriate strategies for improvement. The results showed that the mean duration of preoperative preparation was 55 minutes. The causes of procrastination included insufficient knowledge of nursing staffs in preoperative preparation (72.9%), no appropriate hardware for keeping the patient in lithotomy position, lack of organization of various instruments and materials, no updated instruction manual for instant reference, no in-service education program for nursing staffs, and no standard monitoring procedure for laparoscopic colorectal surgery. After implementation of an intensive training program, integration and purchase of additional laparoscopic instruments, revision of the outdated instruction manual, and establishment of a standard monitoring protocol, the duration of preoperative preparation was curtailed to 25 minutes. In conclusion, the duration of preoperative preparation was successfully reduced through a series of improvement strategies to decrease the operative risk, as well as to improve the quality of operation and patient care.