運用衛教指導提升血液透析患者對高鉀飲食認知之專案

Improving the Understanding of Hyperkalemia among Hemodialysis Patients by Health Instruction

本專案旨在提升血液透析患者對高鉀飲食之認知，於 2010年6月份統計中部某區域醫院血液透析中心之患者高血鉀發生率為24％，血鉀過高會造成心臟麻痹、猝死。經現況分析後，發現問題為：1. 患者對高鉀食物認知不足、閱讀文字衛教單張意願低、缺乏適當的衛教輔助工具；2. 護理人員對高鉀食物認知不一致、衛教指導無標準化遵循、相關教育訓練課程不足。經實施與運用以圖像為主製作成的預防高血鉀飲食照顧手冊、學習光碟、舉辦在職教育及團體衛教等方法後，患者對高鉀食物認知正確率由51.55％提升至75.24％，護理人員對高鉀食物認知正確率由75.20％提升至100％，患者高血鉀發生率已降至14％，獲得良好的成效。

The aim of this project is to help hemodialysis patients improve their understanding of hyperkalemia, a highly risky condition that could lead to cardiac arrest and sudden death. Statistics issued by the hemodialysis center of a local hospital in central Taiwan indicated that the rate of occurrence for hyperkalemia among hemodialysis patients reached 24% in June, 2010. An on-site analysis conducted in the center identified the following problems: 1. The patients did not have adequate awareness of high potassium foods, showed little interest in perusing health education pamphlets, or lacked appropriate health education tools; 2. Inconsistent awareness of high potassium foods among the nursing staff, health education was not standardized, and inadequate training courses. To prevent hyperkalemia, we implemented an image-based diet care manual for the patients utilizing learning VCDs and offered on-the-job training or group education for the nursing staff. The rate of the patients correctly recognizing high potassium foods increased from 51.55% to 75.24% as a result. More importantly, the correct recognition rate of high potassium foods by nursing staff was greatly improved from an average of 75.20% to 100%. The two results combined reduced the occurrence rate of hyperkalemia among hemodialysis patients to 14%, a very impressive improvement.