提升口腔癌病人顯微游離皮瓣存活率之改善專案

Project to Improve the Free Flap Survival Rate in Oral Cancer Microreconstruction Free Flap Surgery

背景：病人在接受顯微游離皮瓣術後，易受內外在因素而影響皮瓣血循。醫護人員在術後照護評估占一重要角色。本單位口腔癌顯微游離皮瓣存活率較低（92.65%），經分析發現主要問題為：（1）護理人員照護認知不足及評估正確率低、（2）缺乏皮瓣照護標準、（3）評估工具不足、（4）團隊機制不完善及（5）無定期稽核。目的：口腔癌病人顯微游離皮瓣存活率由92.65%提升至97%。解決方案：專案小組之決議方案有（1）辦理皮瓣照護教育課程；（2）床邊示範評估教學；（3）發展皮瓣術後照護標準；（4）增設評估工具；（5）建立完善醫護團隊聯繫機制以及（6）擬定稽核機制。結果：2011年12月至2012年5月共施行53位口腔癌病人顯微游離皮瓣手術，皮瓣失敗0件，口腔癌病患皮瓣存活率由92.65%提升為100%。結論：透過教育課程、示範教學、建立術後照護標準、建構團隊聯絡機制及定期稽核，可早期發現皮瓣血循異常徵象，有效提升皮瓣存活率。

Background & Problems: Free-flap thrombosis risk factors affect the success of microreconstruction surgery that involves the use of a free flap. The free flap survival rate in our unit was 92.65%. Relevant risk factors identified included: (1) poor nursing assessment cognizance and low accuracy rates; (2) lack of standardized of postoperative monitoring protocols; (3) lack of assessment tools; (4) inadequate inter-team communication; and (5) lack of a free flap care monitoring audit.Purposes: The purpose of this project was to improve the free flap survival rate from 92.65% to at least 97%.Resolutions: The authors: (1) held relevant educational training programs; (2) evaluated nurse skills in clinical settings; (3) established a standardized nursing monitoring protocol; (4) provided sufficient assessment equipment; (5) improved inter-team communication mechanisms; and (6) formulated a monitoring audit protocol.Result: The free flap survival rate rose from 92.65% to 100%, with no failed flaps during the assessment period December 2011 to May 2012.Conclusion: The resolutions proposed by this project may significantly improve the free flap survival rate.