降低澎湖離島某地區教學醫院血液透析病人高血磷之專案

Project to Reduce Hyperphosphatemia in Hemodialysis Patients at a Regional Teaching Hospital in Penghu

背景：透析病人之血磷值與併發心血管疾病及死亡率息息相關，統計本單位2011 年7 月∼2012 年6 月間，透析病人血磷值大於6.0 mg/dl 比例為32.2％，高於腎臟醫學會之評鑑標準（＜20％），分析原因有：病人疾病和飲食攝取認知不足、服藥遵從性低，以及現有護理指導工具不足、護理指導完整度不足、護理人員知識不足等問題。
目的：降低本單位血液透析病人血磷值大於6.0 mg/dl 之比例。解決方案：改善現有護理指導模式，如製作透析病人就診聯絡簿，提供藥物磨粉及攜帶型藥盒服務，且運用跨醫療團隊模式共同建立一致性護理指導工具，如護理指導單張、光碟、照護手冊、飲食手冊等，並規劃護理人員教育訓練。
結果：於專案執行後，本單位透析病人血磷值大於6.0 mg/dl 比例由32.2％ 降至19.6％。
結論：本專案推行結果除了降低透析病人血磷值，改善病人對疾病及飲食控制認知，更提升本單位對於血液透析病人之照護品質。

Background: The blood phosphate value of dialysis patients is closely associated with cardiovascular disease complications and patient mortality. The data was collected between July, 2011, and June, 2012 in our unit. The percentage of dialysis patients with a blood phosphate value over 6.0 mg/dl was 32.2%, higher than the evaluation standard (< 20%) set by the Taiwan Society of Nephrology. Analysis on the causes of hyperphosphatemia produced the following findings: insufficient patient knowledge of disease and dietary intake, low medication compliance, inadequate nursing education tools, incomplete nursing education and a lack of knowledge among nursing personnel.
Purpose: Reduce the percentage of dialysis patients with a blood phosphate value of over 6.0 mg/dl.
Solution: The existing nursing education mode was improved byproducing dialysis patient contact books, providing a medication pulverization and portable medicine box service, and forming a interdisciplinary team to produce a uniform nursing education toolkit consisting of the nursing education sheet, multimedia CD, care manual, diet handbook and so on. Planning was also carried out on the education and training of nursing staff.
Result: After the project was implemented the proportion of dialysis patients with a blood phosphate value over 6.0 mg/dl decreased from 32.2% to 19.6%.
Conclusion: The implementation of the project not only improved the blood phosphate value of dialysis patients but also enhanced patient’s knowledge of the disease and dietary intake. Finally, it improved the quality of care for hemodialysis patient at our unit.