降低血液透析病患血磷值之專案

A Project to Reduce the Serum Phosphoric Value for the Dialysis Patient with Hyperphosphatemia

本專案是透過品管圈活動，針對長期血液透析病患磷值高於6.0mg/dl之問題進行改善。主要目的是降低透析病患血中磷值，實施方法乃收集病患90.9月至91.2月間每月生化室檢驗之磷值加以分析評估，選出磷值高於6.0mg/d1的病患，設計查檢表找出病患的個別性，確認原因並實行改善方案。經過分析後，血液透析病患血中磷值過高的原因，以外食、藥物劑量不足所佔的比例最高。針對上述二項提出有效改善對策，主要方法有記錄病患飲食日誌、實施護理人員查檢表、建議藥物磨粉後與食物混合服用、給予病患攜帶型藥盒、設計精美卡片以提醒病患服藥、營養師設計低磷飲食表等方法。實施相關護理對策後，透析病患血中磷值高於6.0mg/dl者，由91年4月的30.4%降至91年8月的18.6%，降幅達38.8%。本專案證實經由品管圈的運作可以使透析病患高磷血症獲得控制。

The purpose of this project was to reduce the high phosphoric value (over 6.0mg/dl) in long-term hemodialysis patients through quality control circle (QCC) activity. We attempted to reduce dialysis patients phosphoric values and to establish the standard of care for keeping dialysis patients under the normal phosphoric value. The first step was to identify dialysis patients with high phosphoric values (over 6.0mg/dl) by checking the biochemical test report. Next, these patients were interviewed and related data was analyzed. Finally, major factors which caused the high phosphoric values were analyzed and related improvement methodology was established. The major causes of high phosphoric values were found to be ”eating out at restaurants” and inadequate (low) dose of phosphate-binding drugs. Consequently, we emphasized these two factors as the key for solving this problem. The major methods for improving patient phosphoric values included having patients keep a dietary diary, using nursing checklists, offering portable medication boxes, making a mixture of powdered drugs and food, sending attractive patient reminder cards about medication compliance, and providing patients with nutrition plans using low phosphoric value foods. After implementing the above improvement methods in the hemodialysis unit for four months, the ratio of high phosphoric value (＞6.0mg/dl) patients was reduced from 30.4% in April 2002, to 18.6% in August 2002. This represents a reduction in the percentage of patients with high phosphoric values in this unit of 38.8%. Through using a quality control circle (QCC), phosphoric values of dialysis patients was successfully controlled, and the possibility of related bone syndrome was reduced.