降低血液透析病人動靜脈瘻管阻塞之專案

A Project to Reduce the Arteriovenous Access Occlusion Rate in Hemodialysis Patients

本專案旨在降低血液透析病人動靜脈瘻管阻塞率。經由現況分析發現血液透析病人動靜脈瘻管阻塞可能原因與護理人員瘻管照護知識與技能需要加強，缺乏提供瘻管護理相關工具有關。經由成立跨團隊血管通路照護小組，制定瘻管照護與評核規範、發展並增設瘻管照護工具，規劃並執行護理人員瘻管照護在職教育活動。專案實施後，動靜脈瘻管阻塞率從2.2%降低為0.8%，護理人員動靜脈瘻管功能照護認知得分由56分提升至90分、動靜脈瘻管評估執行率由64.3%提升至85.4%，護理人員聽診判別正確率由68.7%提升至80%。此結果表示提供在職教育、制定臨床作業準則，與常規監測，能有效提升護理人員正確執行率，以及透析病人對照護的滿意度。

The purpose of this project was to reduce the occlusion rate of arteriovenous access in hemodialysis patients. Possible factors contributing to access occlusion included incomplete standard protocols, lack of training on HD access care, and inadequate equipment. An interdisciplinary team was organized. The team member developed several standard protocols on fistula care, provided adequate equipment, and carried out the training and internal auditing program. By implementing this project, arteriove-nous access occlusion rate reduced from 2.2% to 0.8%, nurses' knowledge on HD access increased from 56 to 90, the assessment rate on HD access improved from 64.3% to 85.4%, and the differentiation of auscultation enhanced from 68.7% to 80%. The results demonstrated the effectiveness of the interventions on increasing execution accuracy and patient satisfaction.