按一下以編輯母片標題樣式,按一下以編輯母片文字樣式,第二層,第三層,第四層,第五層,*,*,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,醫療安全暨品質討論會,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 1個案進行臉部及腹部電波拉皮，過程採靜脈麻醉(IV,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 2病人因進行 L5/S1 discectomy，L,Case 3,病人因,tonsillar tumor,入手術室行,Bilateral tonsillectomy,，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。,Case 3病人因tonsillar tumor入手術室行B,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%),。,台灣病人安全通報系統(TPR)自2005年2010年8月間,Tri-Service General Hospital,1 December 1996-28 February 1997,19 cases of skin injury from a total of 3657 operations(0.52%),Injury,1998 Jun;29(5):345-7,Tri-Service General Hospital1,Our experience,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,皮膚完整性受損燙傷(化學性灼傷),医疗安全暨品质讨论会手术过程中病人皮肤完整性课件,医疗安全暨品质讨论会手术过程中病人皮肤完整性课件,Surgical Fires,100 fires each year in USA,10-20 are serious,Med Safety Alert,.2001;6(11):1,Surgical Fires100 fires each y,Element of Fires,Heat or an ignition source,Fuel,An oxidizier,Element of FiresHeat or an ign,医疗安全暨品质讨论会手术过程中病人皮肤完整性课件,The response of green towel and polyprolene drape to the fiberoptic cable and electrosurgical unit,Green towel(cotton)Polypropylene drape,No oxygen Oxygen No oxygen Oxygen,Fiberoptic 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,The response of green towel an,Fire incidents involving fiberoptic light cables and electrosurgical devices reported to the FDA between 1998 and 2006,Fiberoptic Electrosurgical,cable unit,Flash fire(head and neck procedure,O2 in use)0 23,Flash fire with drape fire 0 12,Primary drape fire 2 18,Fire under drape(accumulation of flammable gases)0 7,Primary device fire(spontaneous ignition of device)0 1,Preparatory solution related fire(alcohol-based preparatory solution)0 4,Staff gown fire 0 1,Tracheostomy procedure fire(drapes involved)0 6,Total reported fire incidents 2 71,American Journal of Otolaryngology,2008,29(3):171-176,Fire incidents involving fiber,Burn incidents involving fiberoptic light cables and electrosurgical devices reported to the FDA between 1998 and 2006,Fiberoptic Electrosurgical,cable unit,Drape 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 ,Total reported burn incidents 23 ,American Journal of Otolaryngology,2008,29(3):171-176,Burn incidents involving fiber,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 towels 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/burn risk with electrosur,Fire safety in the operating room,Current Opinion in Anaesthesiology,2008,21:790-795,Fire safety in the operating r,医疗安全暨品质讨论会手术过程中病人皮肤完整性课件,Operation Room Fires:Optimizing Safety,Plast.Reconstr.Surg.,120:1701,2007,Operation Room Fires:Optimizi,Surgical fires,a clear and present danger,The surgeon,2010(8);87-92,Surgical fires,a clear and pr,手術壓瘡,手術壓瘡,Journal of Clinical Nursing,2006;15:413-421,Incidence of pressure ulcers due to surgery(I),Journal of Clinical Nursing 20,Journal of Clinical Nursing,2006;15:413-421,Incidence of pressure ulcers due to surgery(I),Journal of Clinical Nursing 20,Journal of Clinical Nursing,2002;11:479-487,Incidence of pressure ulcers due to surgery(II),Journal of Clinical Nursing 20,Incidence of pressure ulcers due to surgery(II),44 patients(21.2%)developed 70 pressure ulcers in the first 2 post-op day,52.9%on heels,15.7%in sacral area,12%were impaired by the lesions they developed,Journal of Clinical Nursing,2002;11:479-487,Incidence of pressure ulcers d,医疗安全暨品质讨论会手术过程中病人皮肤完整性课件,医疗安全暨品质讨论会手术过程中病人皮肤完整性课件,Intraoperative Pressure Sore Prevention:,An Analysis of Bedding Materials,Research in Nursing&Health,1994,17,333-339,Intraoperative Pressure Sore P,医疗安全暨品质讨论会手术过程中病人皮肤完整性课件,医疗安全暨品质讨论会手术过程中病人皮肤完整性课件,医疗安全暨品质讨论会手术过程中病人皮肤完整性课件,Surgical Positioning,Surgical Positioning,Fig.5.97%of the surgeons see a need for ergonomic improvement,within the operating room.This improvement is not only important in,a single area,but affects all aspects of the OR.,Fig.5.97%of the surgeons se,Ann Surg.,2006 May;243(5):628635,Ann Surg.2006 May;243(5):62,World J Surg,(2009)33:1181-1187,World J Surg(2009)33:1181-11,Chest,(2010)137(2):443-449,Preoperative Briefing in the Operating Room,Chest(2010)137(2):443-449Pre,Conclusion,Recognition,Alert,Improve equipment,Education and Training,Pati