提升血液透析病人降血壓藥物服用遵從性

Enhance Hemodialysis Patients’ Compliance with Antihypertensive Medication

背景：末期腎病變患者約80％具有高血壓，當血壓控制不良，便容易產生左心室肥厚與心臟衰竭造成更高併發症與死亡率。降血壓藥物是透析病人常見用藥之一，往往患者因症狀不明顯，加上長期服藥的繁瑣、藥物副作用等因素，而忽略了血壓的監測與治療。目的：本專案乃探討血液透析病人降血壓藥物服用遵從性低的原因，擬定改善方案。解決方案：經由專案介入進行護理人員在職教育，且配合護理指導手冊、藥物追蹤指導、病人用藥紀錄本、簡易七格藥盒及訂立單位政策。結果：有效的將血液透析病人降血壓藥物服用遵從性由20.7分提升至32.6分，護理人員護理指導執行率由14.3％提升至100％，高血壓服藥病人透析過程不適情形發生率由高峰52.0％減少至24.3％。結論：專案介入措施的確有效提升血液透析病人降血壓藥物服用遵從性，使病人血液透析過程更順利。

Background: 80% of the ESRD patients experience hypertension and improper control of high blood pressures increased the chance of left ventricular hypertrophy and congestive heart failure, leading to complications and higher mortality rates. Antihypertensive agents are one of the drugs that are often used by hemodialysis patients. Patients however usually neglect the importance of monitoring their blood pressure and the consequent treatments due to seemingly insignificant symptoms of high blood pressure, the hassle of long term medication, and side effects of medications.
Purpose: This project investigated the causes of low compliance with antihypertensive agent in hemodialysis patients and developed improvement plans.
Resolution: The intervention project was implemented by providing in-service training program for nurses, instruction manual for care, drug tracking guide, keeping a record of patients’ medication, advising patients to use simple 7-cell medication boxes and establishing a unit policy.
Result: The intervention project effectively increased hemodialysis patients’ antihypertensive medication compliance rate from 20.7 points to 32.6 points. The instruction execution rate of nurses was increased from 14.3% to 100%. More importantly, the incidence rate for dialysis side effects in patients with hypertension was significantly reduced from 52.0% to 24.3%.
Conclusion: The intervention project did effectively improve hemodialysis patients’ compliance with antihypertensive medication and allowed dialysis treatment to proceed more smoothly.