[Using Multiple Strategies to Improve Medication Cognition in Patients After Liver Transplantation].

BACKGROUND & PROBLEMS: Patients with liver transplantation must take lifelong immunosuppressant medication to maintain the function of their hepatic graft. Based on clinical experience, we found that these patients were affected by both insufficient and remaining medication when they returned for outpatient service visits. After investigating the current situation, It was found that post-transplantation perceptions regarding medication were low in this patient group. After analysis, the identified causes of this included: (1) poor learning effect due to the interference from the multiple therapeutic catheter placement postoperatively; (2) delayed timing of assessing the awareness of information or perception of medication and lack of a post-operative follow-up mechanism; and (3) insufficient educational tools and materials for patients. PURPOSE: This study was designed to increase medication awareness from the current average of 68.3% to >91% and to increase patient satisfaction with medication guidance from the current 63.0% to >85% in patients who had received liver transplantation. RESOLUTIONS: The improvement strategy included: designing a health education sheet including related medication information and a daily medication record; designing a mnemonic, interactive video, or test to improve medication perception; creating measures associated with a monitor mechanism to assess medication knowledge. RESULTS: After strategy implementation, medication awareness increased from 68.3% to 92.5% and satisfaction with medication guidance increased from 63.0% to 87.2%. CONCLUSIONS: The implementation of several strategies concurrently can enhance medication awareness in patients after liver transplantation and increase patient satisfaction with medication guidance.

[Using Time Management and Quality Improvements to Decrease the Incidence of Unexpected Skin Defects in Post-Mastectomy Breast Cancer Patients].

BACKGROUND & PROBLEMS: When patients with breast cancer undergo radical mastectomy, seromas are often caused due to the large area of excised breast tissue and the resulting cavity that fills with blood and water. Therefore, strong adhesive elastic tape and large amounts of gauze are needed to compress the wound. Our clinical experience shows that repeatedly removing dressings during dressing changes significantly increases the risk of unexpected skin defects. However, the increased duration of hospital stays required for these patients with skin defects exposes them to high risk environments, which may result in nosocomial infections and even longer hospitalization durations. PURPOSE: This project aimed to decrease the incidence of unexpected skin defects in patients after mastectomy to below 15%. RESOLUTION: After a review of the literature, we implemented this project to: (1) build up a standard operating procedure for post-mastectomy wound compression; (2) use narrow girdles instead of strong adhesive elastic tape; (3) use soft elastic bandages to replace the single layer of gauze for wound compression; (4) use a skin examination form as a continuous monitoring tool. We expected that these measurements would effectively decrease the incidence of unexpected skin defects in post-mastectomy patients. RESULTS: After implementing this project, the incidence of unexpected skin defects in post-mastectomy patients decreased from 100% to 13% and the time required by clinical nursing staff to perform wound dressing care decreased from 25 mins to 15 mins per care instance. CONCLUSIONS: We hope that this project helps effectively improve postoperative wound care quality in post-mastectomy patients and decreases the time spent by clinical nursing staff on wound dressing care.