改善腹膜透析病人發生腹膜炎之專案

Reduction of Occurrence of Peritonitis for a Patient with Peritoneal Dialysis

腹膜透析病人的腹膜炎發生率是腹膜透析的重要品質指標，本單位2009年腹膜炎發生率4.05次/100人月，為全國腹膜炎發生率2.5倍。為有效控制腹膜炎發生，小組由病歷回溯與腹膜透析相關知識技能調查發現，病人腹膜炎發生率高的主要原因為：缺乏合宜衛教工具、執行透析換液認知與技術不正確、缺乏定期評核病人換液技術與認知計劃。藉由制定與修訂腹膜透析衛教工具、舉辦團體衛教、加強病人換液技術再訓練、加強病人認知再衛教、制定技術品質監測計畫及考核表等改善對策後，2010年腹膜炎發生率由4.05次/100人月降至1.42次/100人月；不僅有效降低腹膜炎發生，亦提高腹膜透析病人自我照顧認知與技巧。

Peritonitis is a major complication of peritoneal dialysis; therefore, it becomes a vital quality indicator for peritoneal dialysis (PD). In 2009, among our PD patients, an average of 4.05 patients developed peritonitis per month in every 100 patients. Our PD-related peritonitis (PDRP) occurrence rate was 1.5 times higher than the nationwide PDRP rate in Taiwan. In order to reduce the occurrence of PDRP, Our PD team reviewed the patients' medical records and held a patient survey regarding the PD-associated knowledge and skills. The chart review and patient survey summarized that the major reasons for high occurrence of PDRP were a lack of adequate patient education tool, incorrect knowledge and skills for dialysis solution exchange, and a lack of an evaluation regarding PD patients' knowledge and skills. The improvement measures included establishing the PD patient education tool, setting up peritoneal dialysis patients' group education, reinforcing the skill of dialysis solution exchange and patient knowledge of peritoneal dialysis, and initiating a quality monitoring plan via an evaluation form. The occurrence rate of PDRP decreased from 4.05 patients per month in every100 patients in 2009 to 1.42 patients per month in every 100 patients in 2010. This improvement project not only successfully lowered occurrence of PDRP but also promoted patients' self-care quality.