降低腹膜透析病人水份控制不良率

Improving Inadequate Fluid Control in Patients on Peritoneal Dialysis

腹膜透析病人易發生水份控制不佳，引發心血管併發症。本單位發現水份控制不良病人有45人高達39.5%，甚至因體液容積過多導致住院人數增加。為使病人水份控制不良率下降至低於19.8%，組員深入探討原因為：病人對水份控制配合度及認知不足、水份控制護理指導方式及工具不完善、護理指導時數不足及原版水份控制機制過於簡略，透過研發多元化護理指導教具及錄製多媒體護理指導光碟、成立社群網站上傳相關資訊，舉辦團體護理指導及病友分享會、修訂水份控制標準作業流程，落實電訪及家訪。方案實施後水份控制不良率由39.5%下降至16.7%；水份控制認知正確率由52.2%提升至100%，顯示本專案有良好成效，冀望與各院所分享。

Patients on peritoneal dialysis (PD) are at high risk of cardiovascular disorders and chronic fluid overload. Our investigation found that 45 patients presented with up to 39.5% fluid overload secondary to poor fluid control resulting in increased hospital admission. To reduce fluid overload in PD patients to under 19.75%, the team identified the following causes: poor compliance with fluid intake, poor awareness of fluid control’s importance, improper skills and tools for nursing process, insufficient nursing instruction time, and inadequate patient training brochures. We conducted a project to improve the fluid control for our PD patients by utilizing multimodal training materials, providing updated information via social media such as Facebook, organizing patient training and experience sharing groups, establishing standard protocols for fluid control, as well as conducting regular telephone interviews and home visits. After the completion of the project, the rate of poor fluid control decreased significantly from 39.5% to 16.7% and patients’ recognition of adequate fluid control increased from 52.2% to 100%. Our improvement project demonstrated a positive effect with obvious benefits on fluid control.