降低骨骼銀行取出頭骨時間延遲率

Decreasing the Processing Time of Taking the Skull Bone Flap Out of the Bone Bank

林媛萱(Yuan-Syuan Lin)；張秀玲(Hsiu-Ling Chang)；蕭靜君(Jing-Jun Xiao)

骨骼銀行 ； 延遲率 ； 流程管理 ； bone bank ； delay rate ； process management

志為護理-慈濟護理雜誌

21卷5期（2022 / 10 / 01）

82 - 94

繁體中文

本專案目的為降低骨骼銀行取出頭骨時間延遲率。臨床業務發現骨骼銀行頭骨數量多，但置放空間及存取管理流程未做適當管理，造成人員未依編碼位置放及無法辨識病人資料，導致取出頭骨時間延遲率高。經本專案小組介入解決辦法：1.製作頭骨存放效期說明標示。2.執行過期棄骨及3D掃描作業。3.重新規劃頭骨包裝、編碼及置放位置。4.製作標示牌及登錄本。5.制定「骨骼銀行管理作業辦法」。實際執行七個月後，進行成效評值，其評值結果：1.取出頭骨時間由56分鐘／臺降低至5分鐘／臺。2.取出頭骨時間延遲率由88.9％降低至0。在本單位人員全面支持下，實施成果顯著，現況已作為臨床存取頭骨標準作業流程執行。

This project aims to minimize the processing time of taking the skull bone flap out from the bone-bank. As we reviewed our daily practice, we found that there was no standard practice for operating room staff to handle so many skull bone flaps in an efficient way, which created delays in taking out the bone flaps. Our team tried to solve the problem by: 1. Clearly marking the expiration date of skull bone flaps. 2. Discarding the expired bone flaps and the 3D scans. 3. Re-classifying, re-coding, and re-placing the bone flaps. 4. Making tags and catalogs for the bone flaps. 5. Standardizing the process. After a seven-months long execution of the standard process, we made the following assessment: 1. The average of time needed for taking out the skull bone flap from bone-bank to the operation room was reduced from 56 minutes/unit to 5 minutes/unit. 2. The delay rate of taking the skull bone flap is reduced from 88.9% to 0. The final results showed remarkable improvement, and our protocol has been implemented as a standard procedure for daily clinical practice.

1. 王素秋,施錦珠,洪逸倫,黃惠美,張家慧(2018)。精實醫療管理於手術室之應用。領導護理，19(1)，3-12。
   連結：
2. 謝瑞梅,鍾佩珊,劉欣蓓(2017)。提升人體器官保存庫骨骼收集合格率。護理雜誌，64(6)，85-90。
   連結：
3. 川能倉儲規劃改善(2017，11月28日)．分散式物流管理系統(物流學堂)。https://rack-104.com.tw/4915/
4. Daniel, H.,Ivan, B.,Mumtaz, K.,Charle, B.,Omprakash, D.,Neville, K.,Gabriel, L.(2015).Delay cranioplasty: Outcomes using firzen autologous bone flaps.Craniomaxillofacial Trauma and Reconstruction,8(3),190-197.
5. Fan, M. C.,Wang, Q. L.,Sun, P.,Zhan, S. H.,Guo, P.,Deng, W. S.,Dong, Q.(2018).Cryopreservation of autologous cranial bone flaps for cranioplasty: A large sample retrospective study.World Neurosurgery,109,853-859.
6. Joe, A. H.,Tarek, S.,Ronald, M.(2017).Customized polymethylmethacrylate cranioplasty implants using 3-dimensional printed polylactic acid molds: Technical note with 2 illustrative cases.World Neurosurgery,105,971-979.
7. Lee, C. H.,Chung, Y. S.,Lee, S. H.,Yang, H. J.,Son, Y. J.(2012).Analysis of the factors influencing bone graft infection after cranioplasty.The Journal of Trauma Acute Care Surgery,73(1),255-260.
8. Matthew, P.,M. S. G(2017).Cranioplasty.Neurosurgery Clinics of North America,28(2),257-265.
9. Paolo, F.,Flavia, F.,Federico, B.,Francesca, G.,Massimo, C.,Giancarlo, S.(2019).Management and prevention of cranioplasty infections.Chils’s Nervous System,35,1499-1506.
10. Yeap, M. C.,Tu, P. H.,Liu, Z. H.,Hsieh, P. C.,Liu, Y. T.,Lee, C. Y.,Lai, H. Y.,Chen, C. T.,Huang, Y. C.,Wei, K. C.,Wu, C. T.,Chen, C. C.(2019).Long-term complications of cranioplasty using stored autologous bone graft, three-dimensional polymethyl methacrylate, or titanium mesh after decompressive craniectomy: A Single-Center Experience After 596 Procedures.World Neurosurgery,128,841-850.
11. 王乙茜,林立潔,魏雅雯,陳永鴻(2017)。以ECRS技巧重建手術室骨銀行安全作業流程。醫院雙月刊，50(6)，23-34。
12. 申冀治(2006)。座位需求導入等候理論之設施規劃改善研究。工業科技與管理學刊，1，91-109。
13. 林麗華,劉秋玉,吳幸芬,武麗珠(2014)。降低手術銜接時間延遲率改善方案。領導護理，15(4)，92-104。