血液透析病患水份控制之改善專案

A Project Designed For Improving Fluid Control in Hemodialysis Patients

本專案旨在改善血液透析病患，體液容積過量之護理問題，為提升護理品質及維護病患的權益，於民國90年10月1日至91年5月1日期間，以回朔法調閱九十年度三月、六月及九月超過乾體重5%之病患，發現其水份監測不合格率由25%上升至4%，導致透析間發生低血壓、抽筋、腹痛、胸悶等多項併發症。因此，藉由腦力激盪法提出水份增加之因素，繪製魚骨圖作成調查表。針對規則透析三個月、意識清、可表達，兩次透析間水份超過乾體重5%之患者作調查。共收集調查表一百份，統計分析作成查檢表，繪製成柏拉圖，針對問題：(l)病患缺乏對水份控制的認知(2)衛教內容未標準化(3)缺乏週邊衛教資訊。搜尋文獻研擬對策：舉辦團體衛教、製作衛教單張及專欄、執行日記記錄及監測單。實施後「水份控制超過乾體重5%之不合格率」由改善前51.8%下降至34.4%，而「透析中血壓下降之發生率」亦由60%下降至40%，顯示本專案執行有效益。

This is a project to improve ”Over-volume” in nursing care for Hemodialysis patients. During October 1, 1989 to May 1, 1991, for the purpose of nursing care quality improvement and to protect patients' rights, we reviewed patients' records of ”Over-Dry” cases from March, June and September, 1991. We found the number of hemodialysis patients with problems associated with water caused by monitoring inadequancies increased from 25% to 40%. This has resulted in an increase of patients experiencing complications during hemiodialysis treatment, including hypotension, cramps, abdominal pain; and angina. We chose the patients under the following three circumstances: (l) 5% or more over dry weight shown between consecutive treatments; (2) conscious and could express themselves; and (3) have already had dialysis treatment for three months. According to the results, we made cause-and-effect diagrams for a clear observation. One hundred inquiry lists have been collected. By analyzing the results, made a Pareto Charts analysis. We aimed at the following three problems: (1) patients who lacked knowledge of water control; (2) inadequately educated patients: and (3) patients short of medical information environment to solve the problems: Two solutions were determined: (1) Medical conferences were held with patients; and (2) medical brochures, articles; practicing record and check lists were distributed. The result was a reduction from 51.8% to 34.4% of patients with 5% or more of dry weight, the rate of Hypotension during hemodialysis also was reduced from 60% to 40%. This proves the efficiency of this project.