改善血液透析住院病患透析器凝固專案

The Improvement of Dialyzer Clotting in Hemodialysis In-patients

本專案是透過品管圈活動，針對血液透析住院病患透析器凝固之問題進行改善，其目的係由減少住院病患透析器凝固缺點數，進而降低透析器凝固率，並建立血液透析技術作業標準。實施方法係經由評估病患血液透析器凝固之現況，確定目標並設計查檢表確認原因，對造成透析器凝固之主要原因：未使用抗凝劑、透析中血流量不足及透析中接受輸血治療等提出無抗凝劑透析技術，透析中血流不足之處理技術，透析中輸血技術等之改善對策。結果顯示住院病患透析器凝固缺點數由2.4件/人次，降至1.2件/人次；透析器凝固率由6.6%降至2.8%。並可節省透析器之材料費、感染性廢棄物之處理費、護理人力成本及減少病患因透析器凝固的血液損失而需輸血之費用等，一年可節省總共約五十二萬元，不但增進了病患醫療的品質，也有效降低了醫療成本。本專案並修訂及制定了相關之血液透析技術標準，作為臨床作業之指導準則。

The purpose of this project was to establish the standard procedure of hemodialysis, which could reduce the incidence of dialyzer clotting . The major causes of dialyzer clotting included : non-heparin dialysis, low blood flow and blood transfusion during dialysis. We designed three standard procedues to resolve these problems. The results showed that factors which caused dialyzer clotting were reduced from 2.4 items to 1.2 items per patient; the incidences were reduced from 6.6 % to 2.8%, consequently saving about NT 520,000 dollars last year. These procedures not only improved the quality of patient care but also reduced cost. Related standard procedures of hemodialysis were also revised and established based on the project. They can be used as guidelines on clinical practices.