提升肝動脈人工血管植入流程照護之完整率

Enhance the Completion Rate with Port-A Implantation of Hepatic Artery Care Process

肝動脈人工血管植入及灌注化療是晚期肝癌病人獨特性治療，病人接受植入術後可能會有出血、皮下血腫、感染及導管尖端錯位等併發症，而延遲治療影響腫瘤控制。本專案經現況分析發現腫瘤病房肝動脈人工血管植入流程照護完整率低（55.6%），主要原因包括未建置照護準則、住院醫師每月輪替、無肝動脈人工血管植入流程相關參考資料或工具、不清楚肝動脈人工血管植入流程與照護準則，以及人員疏忽忘記等，引發專案小組改善動機，藉由制定肝動脈人工血管植入流程照護準則、查檢表、技術評核，錄製衛教影片及協助圑隊醫師建置診療醫令套餐，提升肝動脈人工血管植入流程照護之完整率到91.2%，有效減少肝動脈人工血管植入術後的併發症，提升照護品質。 Abstract: Hepatic arterial catheter implantation and hepatic arterial infusion chemotherapy are the specific treatments for advanced stage liver cancer patients. The common complications after catheter implantation include hemorrhage, hematoma, infection and dislocation of catheter tip. These might delay treatment and tumor control. The study showed that completion rate with port-A implantation of hepatic artery care was 55.6%. The major reasons were unbuilt nursing guidelines, the monthly change-of-shift of the attending physician, and the lack of hepatic arterial catheter implantation. The improving strategies include establish the standardized protocol of hepatic arterial catheter implantation, make checklists, skill evaluation, make instructional videos, built computerized physician order entry. These measures enhance the completion rate of hepatic arterial catheter implantation to 91.2%. Thus, our efforts decreased the complications and enhanced the quality of treatment management.

Abstract: Hepatic arterial catheter implantation and hepatic arterial infusion chemotherapy are the specific treatments for advanced stage liver cancer patients. The common complications after catheter implantation include hemorrhage, hematoma, infection and dislocation of catheter tip. These might delay treatment and tumor control. The study showed that completion rate with port-A implantation of hepatic artery care was 55.6%. The major reasons were unbuilt nursing guidelines, the monthly change-of-shift of the attending physician, and the lack of hepatic arterial catheter implantation. The improving strategies include establish the standardized protocol of hepatic arterial catheter implantation, make checklists, skill evaluation, make instructional videos, built computerized physician order entry. These measures enhance the completion rate of hepatic arterial catheter implantation to 91.2%. Thus, our efforts decreased the complications and enhanced the quality of treatment management.