Shu-Chen Chi1 has graduated at the age of 26 years from Central Taiwan University of Science and Technology. She is the nursing staff in the acute stage GI medical ward at Changhua Christian Hospital and have wored 20 years until now.
Patients with an obstructed or an infected biliary tract are easily susceptible to biliary disease. This condition must be treated timely using a biliary tract drainage catheter to avoid life-threatening complications. Such treatment can help the patient to maintain smooth flow of the bile, thereby avoiding septic shock that endangers the health and safety of the patient. Therefore, the biliary tract drainage catheter must be placed in the biliary tract on time for treating this disease. In our gastrointestinal (GI) ward, patients with biliary disease generally undergo in situ drainage. Recently, we have been observing a high slippage rate of biliary tract drainage catheter, which not only endangers the safety of the patient’s health but also prolongs the treatment time. Therefore, a team was formed to improve this condition, which identified the following problems: that the drainage catheter needs improvement in the fixing methods, differences existed in the biliary tract drainage catheter, the drainage catheter could be pulled out easily, there was a lack of a standard process for uniform fixing of the drainage catheter, and there was a lack of an audit system. When the team had analyzed and established the problem, few measures were proposed, which included simplifying the drainage catheter fixation procedure, unifying the drainage catheter fixation dressing, implementing the use of pins to fix the pipeline, revising the drainage catheter care procedure, and checking the implementation of the pipeline care effectiveness regularly. After implementing these administrative protocols, the drainage catheter slippage rate decreased from 3.6% to 0.5%, thereby indicating that the purpose of this project has been achieved. The implementation of these administrative protocols not only paved the way to use the project’s achievements in clinical care but also alerted us to be more cautious for preventing drainage catheter slippage, reducing patient injury, and improving the quality of care whenever there is a need to provide drainage catheters by the nursing staff.
After graduation from school in 1978, I began my nursing career in Intensive Care Unit of MacKay Memorial Hospital, Taiwan. In the same year, I have successfully and proficiently completed Emergency and Critical Care Nursing Training Course of MacKay Memorial Hospital. Since 1979, I began to work in Operation Room and was quite attracted by the working environment. I have joint the service of Medical Team from Taiwan in Saudi Arabia for one year around 1980. In 1991, I received the training of Nursing Administration for Head Nurse. In 1992, I was promoted to be the Head Nurse of Operating Room in MacKay Memorial Hospital. I am certified for the Peri-operative Registered Professional Nurse in Taiwan and a current member of Taiwan Nurses Association
The study aims to explore the differences between unplanned return operation and the planned surgery in patient¡¦s length of stay in hospital, in intensive care unit (ICU) and died within 30 days after surgery. Methods: The study adapted retrospective and case match design. Data source was 15,024 hospitalized surgical patients, included inpatient surgery and after emergency surgery, from a medical center in northern Taiwan. Experimental group (unplanned return) was accordance with the type of surgery by physicians ticked (n=185). Control group (planned surgery) patients was matched sequentially according to the experimental patient's surgery department, sex, and age (¡Ó 2 years) (n=352). Using STATA11.2 software distributes to the frequency, percentage, the average, standard deviation, chi-square test, t test, ANOVA analysis, logistic regression and multiple regression analysis. Results: Under the control of patient¡¦s anesthesia type, operation duration, wound classifications variables, compared to the planned surgery, unplanned return surgery does significantly affect the length of stay in hospital (£]=0.889, p=0.000), stay in ICU days (£]=0.628, p=0.001). The occurrence of unplanned return surgery patients died within 30 days after surgery was significantly higher than planned surgery does (OR=3.39, P=0.026). Conclusion: These results confirm the difference in length of stay in hospital, ICU and died within 30 days after surgery of unplanned return surgery patients compare to the planned surgery. Unplanned return surgery rates may be useful for monitoring quality across hospitals and for identifying opportunities for quality improvement locally.