運用隨身工具降低某血液透析室病人高血磷之發生率

Using Portable Tools to Reduce the Incidence of Hyperphosphatemic Patients in a Hemodialysis Room

高血磷之併發症不僅增加醫療成本支出更威脅病人健康及生命，如何改善病人血磷值過高並控制在≦5.5mg/dl是相當重要。收集2013年10月至2014年3月常規抽血報告發現病人血磷值＞5.5mg/dl平均每月高達27％∼36％。專案小組旨在降低病人高血磷之發生率。確立問題：護理指導手冊攜帶不便和字體太小、高磷食物種類多、口頭衛教不易記住、食物由家人準備及外食忘記帶藥。改善對策：修訂護理指導手冊、製作影音多媒體衛教影片；設計病人隨身工具：磷結合劑隨身瓶、高磷食物鑰匙圈及聯想圖。實施後病人血磷值＞5.5mg/dl平均比率由29.1％降至17.9％。專案成效維持，不僅控制病人血磷值也提升護理照護品質。

Complications of hyperphosphatemia not only increase medical costs but also threaten the life and health of patients; it is therefore crucial to reduce elevated serum phosphate levels in patients and keep it below ≦5.5 mg/dl. Results of routine patient blood tests between October 2013 and March 2014 showed that the percentage of patients with serum phosphate levels above 5.5 mg/dl was as high as 27%~36% every month. The goal of the project team was to reduce the incidence of hyperphosphatemia. Issue identification: The nursing manual is cumbersome to carry with fonts that are too small to read; the types of foods with high phosphate levels varied greatly, and oral health education was difficult to memorize; food prepared by family members and forgetting to bring medications when eating out. Improvement strategies: The nursing manual was revised and multimedia health education videos produced; portable tools were designed for patients such as bottles for the phosphate binder that can be carried anywhere, key chains listing foods high in phosphorus, as well as diagrams to help with memorization. Upon implementation, the incidence of patient serum phosphate levels above 5.5 mg/dl dropped from 29.1% to 17.9%. The strategy not only helped to control patients’serum phosphate levels but also improved quality of care as well.