血液透析護理人員疼痛照護改善專案

A Pain Care Improvement Project for Hemodialysis Unit Nursing Staff

目的：本文主要改善血液透析護理人員疼痛照護完整率，由於透析病人疼痛盛行率高，透析過程中因疼痛提早結束透析治療，降低透析品質，故藉由護理人員提供完整疼痛照護措施，改善病人疼痛之不適感，而能達到足夠的透析治療，進而提高透析品質、生活品質及生存率。方法：單位由Ho pe系統透析指標中，發現尿素氮廓清率（Kt/V）小於1.2者有20人，進行原因分析發現透析時間不足為首要原因，其中因疼痛而提早結束透析者佔透析人數1/3。進而查閱病例發現，單位有30人（26.8％）曾因疼痛提早結束透析治療，導致透析時間不足，廓清率降低影響透析品質，故成立專案小組進行改善，專案執行前疼痛照護完整率24.9％；疼痛認知正確率50.9％。分析原因：1.護理人員疼痛認知不足2.無疼痛照護標準規範3.缺乏稽核制度4.無疼痛護理記錄單5.無輔助衛教工具。措施包括1.舉辦疼痛在職教育2.執行「第五生命徵象」評估3.落實稽核與獎懲4.制定疼痛護理記錄單5.制定護理指導單6.錄製疼痛衛教影片。結果：疼痛照護完整執行率由24.9％提升至6.4％；疼痛認知正確率由50.9％提升至98.3％。結論：經專案實施發現定期舉辦疼痛相關在職教育提升護理人員照護認知；制定血液透析疼痛照護標準規範；並將疼痛列入「第五生命徵象」評估；提供病人合適的輔助衛教工具等，確實可明顯提升護理人員疼痛照護完整率。

Purposes: The purpose of the pain care improvement project was to improve the pain care completion rate by hemodialysis nurses. The prevalence of pain is high in dialysis patients,frequently resulting in termination of dialysis treatments and reducing the quality of dialysis. Therefore, hemodialysis unit nurses attempt to alleviate the painful sensation,achieve adequate dialysis treatments, and improve the quality of dialysis, quality of life, and survival by providing complete pain care measures. Methods: We analyzed the indicators of quality of dialysis using the Hope System and found that the urea nitrogen clearance (Kt/V) was < 1.2 in 20 patients. The primary cause for the low Kt/V was a shortened duration of dialysis treatment; in fact, one-third of the patients had pain-related early termination of dialysis treatment. Based on a review of the medical charts, there were 30 patients (26.8%) with early termination of dialysis treatment because of pain, resulting in an inadequate duration of dialysis and reduced clearance, which together affected the quality of dialysis. Therefore, we initiated the pain care improvement project to manage this issue. Before the project, the pain care completion rate was 24.9% and the accurate pain perception rate was 50.9%. An analysis of causes of the pain care completion and accurate pain perception rate revealed the following: 1. the nursing staff was not well-trained in pain perception; 2. no standard pain care guidelines; 3. no system of pain assessment; 4. no pain care nursing records; and 5. no auxiliary health education tools. The recommended measures included: 1. organizing pain care in-service education; 2. performing a 'fifth vital sign' assessment; 3. implementing audits, rewards, and punishments; 4. developing pain care nursing records; 5. formulating nursing instructions; and 6. making pain care health education videos. Results: The pain care completion rate increased from 24.9% to 96.4%, and the pain perception rate increased from 50.9% to 98.3%. Conclusions: After implementing the project, we found that organizing regular pain care in-service education could improve the pain perception rate pain of the nursing staff. Formulating hemodialysis pain care nursing instructions, incorporating pain assessment as a 'fifth vital sign', and providing appropriate pain care health education appliances could raise the pain care completion rate of the nursing staff significantly.