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1、,醫療安全暨品質討論會手術過程中病人皮膚完整性 台北醫學大學附設醫院一般及消化外科實證醫學中心譚家偉 主任,Case 1,個案進行臉部及腹部電波拉皮，過程採靜脈麻醉(IVG)，清醒後發現腹部燙傷產生水泡。,Case 2,病人因進行 L5/S1 discectomy，L3/4 laminectomy and Internal fixation術式需要手術姿勢為俯臥。病人臉部、胸腹部、雙手、雙膝及小腿下皆有保護措施，但術後仍發現病人產生壓瘡：前胸兩邊肋骨處約2x5cm左右的水泡、手肘內側(約3x4cm)及臉部破皮。,Case 3,病人因tonsillar tumor入手術室行Bilateral t
2、onsillectomy，術中刷手護理人員未與巡迴人員相互確認，將稀釋後的雙氧水當成局部麻醉藥給醫生使用，醫生使用後發現有組織燒灼傷現象，約2x2x0.1公分化學灼傷，向刷手與巡迴人員確認，巡迴人員表示無給予刷手人員局部麻醉藥物，才發現此異常。,台灣病人安全通報系統(TPR),自2005年2010年8月間通報事件中，與皮膚完整性受損相關事件共985件，其中燙傷事件共287件(約佔29%)。,Tri-Service General Hospital,1 December 1996-28 February 199719 cases of skin injury from a total of 36
3、57 operations(0.52%),Injury 1998 Jun;29(5):345-7,Our experience,皮膚完整性受損,燙傷(化學性灼傷)電燒雷射手術壓瘡Other,Surgical Fires,100 fires each year in USA10-20 are serious,Med Safety Alert.2001;6(11):1,Element of Fires,Heat or an ignition sourceFuel An oxidizier,The response of green towel and polyprolene drape to th
4、e fiberoptic cable and electrosurgical unit,Green towel(cotton)Polypropylene drape No oxygen Oxygen No oxygen OxygenFiberoptic cable Resting-Buried Yellow(2 min)Yellow(2 min)Hole(15 s)Hole(15 s)Electrosurgical unit 1 W-10 W-30 W-Skin burn,American Journal of Otolaryngology 2008,29(3):171-176,Fire in
5、cidents involving fiberoptic light cables and electrosurgical devices reported to the FDA between 1998 and 2006,Fiberoptic Electrosurgical cable unitFlash fire(head and neck procedure,O2 in use)0 23Flash fire with drape fire 0 12Primary drape fire 2 18Fire under drape(accumulation of flammable gases
6、)0 7Primary device fire(spontaneous ignition of device)0 1Preparatory solution related fire(alcohol-based preparatory solution)0 4Staff gown fire 0 1Tracheostomy procedure fire(drapes involved)0 6Total reported fire incidents 2 71,American Journal of Otolaryngology 2008,29(3):171-176,Burn incidents
7、involving fiberoptic light cables and electrosurgical devices reported to the FDA between 1998 and 2006,Fiberoptic Electrosurgical cable unitDrape burn without patient injury 4 Drape burn with patient injury 3 Direct patient burn 12 Direct staff burn 3 Equipment(camera damaged by fiberoptic cable)1
8、Total reported burn incidents 23,American Journal of Otolaryngology 2008,29(3):171-176,Fire/burn risk with electrosurgical devices and endoscopy fiberoptic cables,Fiberoptic cables and electrosurgical generators represent a serious burn risk for surgical patients,with operating room drapes and towel
9、s affording only limited protection.,Large hole in a polypropylene drape after exposure to a fiberoptic light cable connected to a 300-W xenon light source,American Journal of Otolaryngology 2008,29(3):171-176,Fire safety in the operating room,Current Opinion in Anaesthesiology 2008,21:790-795,Opera
10、tion Room Fires:Optimizing Safety,Plast.Reconstr.Surg.120:1701,2007,Surgical fires,a clear and present danger,The surgeon 2010(8);87-92,手術壓瘡,Journal of Clinical Nursing 2006;15:413-421,Incidence of pressure ulcers due to surgery(I),Journal of Clinical Nursing 2006;15:413-421,Incidence of pressure ul
11、cers due to surgery(I),Journal of Clinical Nursing 2002;11:479-487,Incidence of pressure ulcers due to surgery(II),Incidence of pressure ulcers due to surgery(II),44 patients(21.2%)developed 70 pressure ulcers in the first 2 post-op day52.9%on heels15.7%in sacral area12%were impaired by the lesions
12、they developed,Journal of Clinical Nursing 2002;11:479-487,Intraoperative Pressure Sore Prevention:An Analysis of Bedding Materials,Research in Nursing&Health 1994,17,333-339,Surgical Positioning,Fig.5.97%of the surgeons see a need for ergonomic improvementwithin the operating room.This improvement
13、is not only important ina single area,but affects all aspects of the OR.,Ann Surg.2006 May;243(5):628635,World J Surg(2009)33:1181-1187,Chest(2010)137(2):443-449,Preoperative Briefing in the Operating Room,Conclusion,RecognitionAlertImprove equipmentEducation and TrainingPatient Safety ProtocolFull implementation,Thanks for your attention,
