血液透析病人高血磷護理指導改善專案

A Study on Improving Education Regarding Prevention of Elevated Serum Phosphate in Hemodialysis Patients

「高血磷」是透析病人最常發生、也最易忽略的問題。對病人雖然不會有立即的生命危險，但長期累積卻是造成透析併發症的重要原因。本專案針對長期血液透析病人進行調查，發現衛教時間及資料不足，病人不清楚高磷食物，未養成吃藥習慣及服藥方法錯誤等問題為病人高血磷的要因。實施對策包括：(1)兩兩互助的新衛教模式－－解決衛教時間不足問題；(2)置入式行銷法－－透析中播放衛教影片；(3)創新磷結合劑服法－－解決口感不好、忘記帶藥及餐間服用隱密性與老人咬不動的困境；(4)藥袋新增藥物說明。專案實施後血清磷值大於6.0 mg/dL的病人由25.6%下降至17.9％。藉創新降磷藥劑服用，養成病人規律服藥的習慣，成效頗佳，期藉本專案經驗提供透析院所照護指引。

The purpose of this study was to explore the factors associated with inadequate phosphate control in hemodialysis patients and to implement measures to achieve good phosphate control. We administered a questionnaire to determine the level of understanding about hyperphosphatemia by the long-term hemodialysis patients and then developed relevant measures after analysis of the responses. These included : (1) a new health education model with two nurses for each patient (2) the approach of product placement as we played a video during hemodialysis (3) the use of innovative phosphate binders by dissolving daily doses in a 150ml cup of soup in order to solve the problem of bad taste. It seemed easier and more private to carry the cup than the medicine. This also solved the problem of bad teeth in aged patients. After the implementation of this program, the percentage of patients with serum phosphorus levels > 6.0 mg/dL dropped from 25.9% to 17.9%. More hemodialysis patients developed the regular habit of taking phosphate binders. The results were impressive and we suggest this program as a nursing care reference for achieving better serum phosphate control in hemodialysis patients.