運用衛教指導技巧提升腹膜透析病人血磷控制之成效

Using Health Education Skills to Enhance the Effectiveness of Phosphorous Control in Patients Undergoing Peritoneal Dialysis

透析病人長期高血磷易產生合併症並導致死亡率增高。經現況分析發現2015年11月血清磷離子＞6.0mg/dl發生率39.3％，原因為︰缺乏對疾病及正確的飲食相關知識、不遵從衛教內容、未能正確服用藥物；缺乏標準化護理指導流程、衛教時間不足；缺乏高血磷衛教手冊及團體衛教。經由文獻查證後擬定解決方案：標準化高血磷護理指導流程、規劃團體衛教、製作飲食衛教手冊、服藥提醒卡及衛教海報、定期電訪、以手機程式進行飲食紀錄及衛教。經以上措施後血清磷離子＞6.0mg/dl發生率由39.3％下降至20.6％，獲得良好成效。本結果建議透析院所與病人建立網絡，透過網路影像傳輸即時討論，藉此大幅提升病人照護的成效。

Hyperphosphatemia in dialysis patients raises the probability of complications and leads to increased mortality. In November 2015, 39.3% of the patients in our unit recorded serum phosphate levels over 6.0 mg/dl. Analysis identified the following key factors: lack of awareness on the disease and high phosphorus foods, patients not taking medications properly, no standardized health education for patients, insufficient time for health education, lack of a high serum phosphate education manual and group health education. The solutions were as follow: standardized hyperphosphatemia education process; organizing of health education activities; the production of a health education manual, medication reminder cards and health education posters; regular telephone interviews; and using mobile apps to keep a record of patient diet and for health education. The implementation of the above measures saw the incidence of serum phosphate > 6.0 mg/dl among patients in our unit decrease from 39.3% to 20.6%. The measures were therefore shown to be effective. We recommend establishing an Internet connection between the dialysis center and the patient for real-time video conferences over the network to significantly enhance the effectiveness of patient care.