提昇接受肝動脈栓塞術後個案照護滿意度之專案

A Project of Promotion the Satisfaction in Hepatocellular Carcinoma Patients who Received the Transcatheter Arterial Embolization

本專案旨在應用改良式砂袋及砂袋固定帶是否可以提昇肝癌病人接受肝動脈栓塞術後照護滿意度調查。專案動機係因肝癌患者接受肝動脈栓塞術後需用砂袋加壓的抱怨所引發。專案小組藉由問卷調查，病人施行砂袋加壓期間不能移動身體導致腰酸背痛、傷口疼痛、擔心砂袋掉落導致傷口出血、護理人員未能注意病人隱私、護理人員僅採口頭衛教、缺乏支托設備等原因，導致病人照護滿意度降低。經由擬定肝動脈栓塞術後護理指導單張、設計砂袋加壓固定帶與設計1公斤砂袋、增設腰靠及側臥枕支撐體位、增設肝動脈栓塞術後病人提醒卡、制定肝動脈栓塞術作業流程品質監控指標等六項措施後，病人的舒適滿意度由實施前的1.39分提昇到4.57分，明顯提昇肝癌患者接受肝動脈栓塞術後砂袋加壓舒適的滿意度。期望本專案的經驗及創新砂袋加壓固定帶及1公斤砂袋之應用能作為類似案例改善的參考。

The purpose of project is to explore patients’ comfortable satisfaction toward application of a modified pressurized sand bags for reducing bleeding among hepatocellular carcinoma (HCC) patients who received transcatheter arterial embolization. During care of HCC patients, we found that the patients’ complaints and low satisfaction toward using pressurized sand bags after transcatheter arterial embolization. By survey and analysis, our panel found that the causes of low comfortable satisfaction were: lower back pain caused by limited body movement, wound pain, concern about bleeding after falling sand bag, violation of privacy by nursing staff, insufficient verbal health education, and lack of support equipment, etc. The strategies for improving satisfaction were: development of caring instruction sheets after transcatheter arterial embolization, design of pressurized sand bags aids, provision of additional support equipment care position, use of a modified sand bag, use of additional reminder tools, and development of quality control indicators after transcatheter arterial embolization. The outcomes of this project shows the comfortable satisfaction increased from 1.39 to 4.57. It significantly improved the comfortable satisfaction. We expect that the experience of this project and innovative application of assistive devices can serve as a reference of similar cases.