血液透析病患高血鉀預防衛教改善專案

A Study on Improving Medical Education with Regard to the Prevention of Elevated Serum Potassium in Hemodialysis Patients

本專案的目的在維持血液透析病人，血清鉀離子值維持低於5.5mEq L的比率，經由本專案之執行，統合單位護理指導內容及衛教之一致性，提昇透析病人對鉀離子升高的危機意識及自我居家照顧能力，進而降低透析病人鉀離子升高發生率。同時分析得知護理人員衛生教育成效不佳、病人自我照護不足、飲食控制不良等，是嚴重影響透析病患血清鉀離子值升高之因素。本專案執行之改善方案為：一、制定預防高血鉀衛教照護標準作業，內容包括設計警示小卡、高血鉀護理計劃單、訂定衛教執行辦法。二、加強透析病人衛生教育，製作海報及衛教單，並舉辦腎友座談會。三、加強護理人員的在職教育，舉辦讀書會、設計食物代換表供同仁參考。統計2007年1月專案改善前，透析病人血清鉀離子大於5.5mEq L之比率為23.8﹪；2007年6月專案執行後，透析病人血清鉀離子大於5.5mEq L之比率降低為10.7﹪。本專案實施結果有效降低腎友透析前鉀離子升高之比率，提升單位之護理專業品質，進而確立本單位護理人員血清鉀離子護理指導之標準作業流程。

The purpose of this study was to improve the maintenance of serum potassium at a level lower than 5.5 mEq/L in hemodialysis patients by changing the nursing care instructions in our hemodialysis unit. Specifically, this involved raising the level of awareness of the inherent dangers of hyperkalemia, improving the self care ability at home among our hemodialysis patients and delivering better control of dietary intake among hemodialysis patients. These processes involved the following steps. Firstly, creating standard nursing guidelines with regard to health education for the prevention of hyperkalemia including the use of small alarm cards, the use of hyperkalemia nursing management forms and establishing of appropriate health education. Secondly, the reinforcement of health education among hemodialysis patients using posters, health education brochures, seminars and symposia. Finally, on-the-job training of nursing personnel was set up involving special sessions, book reports and help with designing dietary plans. On January, 2007, before the start of this study, the percentage of hemodialysis with serum potassium levels greater than 5.5 mEq/L was 23.8%. At the conclusion of this study in June 2007, this had fallen to 11% .This clearly demonstrated the effectiveness of our approach and that our goal of improving serum potassium levels among our hemodialysis patients had been reached. Thus, the quality of nursing care in the hemodialysis unit was improved and our approach can be used as a standard for the nursing and management of hyperkalemia.