改善血液透析患者血比容積偏低專案

A Project to Improve Hemodialysis Patients' Low Hematocrit

本專案旨在降低血液透析個案血比容積偏低的比率，經調查發現本院血液透析患者血比容積（Hematocrite,HCT）平均值為28.7%，其中46%個案血比容積<28%，平均每人每月使用合成基因紅血球生成素（r-HuEPO）高達19000U，引發成立專案小組改善。經現況分析確立問題有：個案對貧血相關知識缺乏、個案缺乏鐵劑、個案營養不良、透析管路血液回收不全及r-HuEPO採靜脈注射而影響吸收。經由改善方案：改變r-HuEPO注射途徑、更換鐵劑廠牌改善過敏問題、舉辦貧血相關之衛教、製作衛教海報及DVD、制定透析結束收針標準。經實施上述各項改善措施後，透析個案HCT<28%者由改善前46%降至21%；r-HuEPO的使用量也由改善前平均每人使用19000U降至15712U，不但改善透析個案之貧血情形，更降低醫療成本的支出。An investigation showed that the average hematocrit(HCT)of the dialysis patients in this hospital was 28.7%,and 46% of the patients actually had a HCT lower than 28%. The avarage dosage of r-HuEPO administered per hemodialysis patient per month was as high as 19000U. The aim of a designed improvement project wsa to decrease the percentage rate of hemodialysis patients with low HCT(HCT<28%).The identified problems based on data analysis included insufficient iron supplement ofor patients receiving hemodialysis, patients'lack of knowledge about anemia, patients' poor nutritional status, incomplete blood transfusion return from the dialysis catheters, and patient's poor absorption of r-HuEPO via intravenous route. The designed improvementmeasures changed the injection route for r-HuEPO administration, changed the brand of iron supplement to eliminate allergy, provided educational seminars on anemia, produced educational posters and DVD's , and established the procedure standards for the closure of hemodialysis. Since the above measures were implemented, the percentage of patients with low HCT had been reduced from 46%to 21%.The average dosage of r-HuEPO adminstered for hemodialysis patients had been reduced from 19000U to 15712U per patient per month. The project not only improved patients' anemic status, but also reduced the medical costs.