運用影像傳輸系統提昇護理人員乳房重建術後皮瓣評估一致性

Project of Applying Image Transmission System to Promote the Consistency of Flap Assessment for Breast Reconstruction

皮瓣顏色對於接受乳房重建術後病人很重要，是顯微手術的關鍵，護理人員皮瓣評估與醫師判斷有誤差，可能延遲異常皮瓣處理，造成皮瓣移植失敗。本專案目的為運用數位影像傳輸模式，通報乳房重建術後皮瓣評估結果，以增加醫護人員於術後皮瓣評估的一致性。現況中發現護理人員對術後皮瓣顏色評估判斷一致性僅65.7%，因通報流程問題導致皮瓣處理時效異常件數3 件，通報及處理時間平均為3小時。專案小組經問題分析、探究對策等步驟，設立改善方案包括：(1)運用數位影像即時傳輸皮瓣照片、(2)修改皮瓣色卡、(3)建立異常皮瓣顏色圖檔及(4)修訂病房常規通報流程。經介入上述改善措施後，護理人員對術後皮瓣顏色評判斷一致性提升至100%，因評估通報流程問題導致皮瓣處理時效異常0件，通報及處理時間縮短為8分鐘。本專案為建立客觀皮瓣評估方法，促進醫護間皮瓣評估溝通，縮短異常皮瓣處理時效，降低再次手術的機率。

Flap color of breast reconstruction is crucial during postoperative period. The inconsistency of flap assessment between nurses and physicians might delay the timing of salvage and resulting in flap graft failure. The purpose of the project was to apply image transmission system to promote consistent flap assessment for breast reconstruction postoperative among nurses. Before the project, the consistency of flap assessment was 65.7%. There had been 3 events of delayed salvage due to reporting process. The average time between reporting and management of flap was 3 hours. After analyzing the current procedures, current project of improvement included: (1) applying digital image to timely transfer flap pictures; (2) modifying flap color cards; (3) building abnormal flap color files; and (4) revising standard reporting procedures. After the improvement project, the consistency of flap assessment among nurse staff increased to 100%. The number of delayed reporting decreased to 0. The average time between reporting and management of flap decreased to 8 minutes. The project has constructed an objective way for flap assessment, promoted communication between nursing staff and physicians, and shorten the timing of salvage, and successfully decreased the need for reoperation.