提升消化道癌症住院患者營養照護追蹤率之專案改善

Improving the Tracking Rate of Nutritional Care for Patients Hospitalized with Digestive Tract Cancer

目的：住院患者營養狀況追蹤是提升患者營養照護品質非常重要的策略。因此，本研究擬以整合性營養照護追蹤策略以提升消化道癌症住院患者營養訪視追蹤率與患者之熱量攝取量。方法：本研究第一階段藉由結合癌症防治中心、營養課及醫療科成立專案小組，進行流程檢視及分析追蹤率低原因後，依其原因再擬定與執行新照護方案。結果，本院消化道癌症患者營養照護追蹤率低之主要原因為：照護者不了解患者治療頻率、時程和動向，以及訪視名單來源不正確。二階段則以第一階段結果擬定新照護方案內容包括：推動團隊照護模式、推行轉介機制，並修訂訪視名單來源。結果：新照護方案執行後，營養照護之訪視追蹤率顯著提升，食慾不佳患者飲食攝取量有顯著提升之外，更延緩體重流失。且患者對營養照護滿意度由83.6分提升至90.0分，針對「衛教內容是否符合您的需求」之得分也由78.5分提升至90.0分。消化道癌症患者於營養介入後，熱量及蛋白質攝取有顯著提升（p＜0.05），且達每日飲食建議攝取量的75％以上。結論：本研究結果顯示，跨領域團隊合作醫療照護確實能提升消化道癌症患者之營養品質。

Purposes Tracking nutritional status is a critical strategy for improving the care quality of hospitalized patients. Therefore, this study intends to use an integrated nutritional care tracking strategy to increase the caloric intake among hospitalized patients with digestive tract cancer. Methods In the first phase of this study, a special project group was formed that combined teams from both the Cancer Prevention Center with Nutrition and Medical Divisions. After examining the procedure and analyzing the reasons for low tracking rates, a new care plan was developed and implemented. We found that the main reasons for a low nutritional care rate of patients with digestive tract cancer in this hospital include caregivers not understanding the frequency, duration, and trends of treatment, as well as an incorrect source of the visit list. In the second phase, a new care plan was proposed based on the results of the first phase and included the promotion of the team care model, implementation of the referral mechanism, and revision of the source of the visit list. Results After the implementation of the new care plan, the visit tracking rate for nutritional care and the dietary intake of patients experiencing loss of appetite was significantly improved, and weight loss was delayed. Patients' overall satisfaction for nutritional care increased from 83.6 to 90.0, and the score for “whether the health educational content meets your needs” also increased, from 78.5 to 90.0. After nutritional intervention, patients with digestive tract cancer had a significant increase in calorie and protein intake (p<0.05) and achieved more than 75 of the recommended daily dietary intake. Conclusions The results of this study show that cross-disciplinary medical care can improve the nutritional quality of patients with digestive tract cancer.