Breast Cancer Patient Flap Management after Mastectomy: A Best Practice Implementation Project

Abstract

BackgroundBreast cancer is a prevalent malignancy in women, with mastectomy as the main surgery. Common post-mastectomy complications are seroma (15%-81%), infections (2.9%-3.8%), and flap necrosis (10%-18%), severely impacting quality of life and costs. Howerever, there's a lack of standardized flap care protocols and limited staff knowledge. ObjectivesThis study aims to apply best evidence for flap management post-mastectomy to standardize practices, reduce complications, and enhance patient's quality of life. MethodsThis project followed JBI PACES and GRiP principles, implementing evidence-based practices in a Chinese tertiary hospital between January and May 2023. It entailed evidence identification, integration into clinical context, protocol development, baseline audits, barrier/enabler analysis. The study compared pre- and post-evidence implementation rates of flap complications, healthcare staff's knowledge/skill scores on mastectomy flap management, and audit indicator adherence by both staff and patients. ResultsAfter evidence application, flap ischemia/necrosis rates dropped from 8.57% to 5.56% (P<0.001), wound infection rates after surgery reduced from 5.71% to 2.78% (P<0.001), and seroma rates decreased from 17.14% to 2.78% (P<0.001). Healthcare staff's knowledge and skill scores for flap management following mastectomy increased from 50.67±18.32 pre-implementation to 98.33±4.01 (t=-13.90, p<0.001). Audit criterion compliance rates increased from 8.57% to 94.29% to between 91.67% and 100%, with statistically significant differences in all 15 criteria (P<0.001). ConclusionsEvidence-based management of flaps after mastectomy improves healthcare staff's knowledge and skills, enhances nursing quality, effectively reduces flap complications in patients, and boosts their quality of life. micro abstractThis study implemented evidence-based practices for post-mastectomy flap management at a Chinese tertiary hospital, reducing complications: flap ischemia/necrosis from 8.57% to 5.56%, infections from 5.71% to 2.78%, and seroma from 17.14% to 2.78%. Healthcare staff's knowledge and skills improved significantly, boosting compliance with audit criteria. Results indicate enhancements in nursing quality and patient quality of life.