提升護理人員對腎臟移植術後病人用藥護理指導之完整性

Improving the Completeness of Nursing Staff’s Instruction on Medication Use to Kidney Transplant Patients

腎臟移植術後，免疫抑制劑為術後存活率重要因素，為提升術後病人服藥安全，透過護理指導增強自我健康管理，故進行改善。經現況分析確立問題為護理人員缺乏腎臟移植術後用藥指導標準程序、與藥師共同指導步調不一致、缺乏在職教育訓練、單位缺乏提供護理人員腎臟移植用藥指導指引、腎臟移植衛教手冊不完整、用藥指導未詳細交班及對於腎臟移植藥物認知待加強。解決辦法為建立跨團隊用藥指導標準程序、舉辦護理人員腎臟移植用藥教育訓練、增設護理人員執行腎臟移植術後病人用藥指引手冊、建立腎臟移植術後病人用藥指導查檢表、建置腎臟移植術後病人用藥套餐等措施。結果護理人員對腎臟移植病人術後用藥護理指導完整性由70.0%提高99%，達到專案目的。結論透過跨領域專業間合作藉由移植團隊醫師、藥師、護理師與協調師，以病人為中心建置共同目標，確實可達到病人按時服藥安全目的。

Appropriate maintenance of immunosuppressants use is one of the important factors influencing the post-operative survival rate in kidney transplant patients. This project aimed to improve patient’s medication safety by providing nursing instruction to enhance patient’s self-health management. Our investigation revealed some problems might influence patient’s knowledge of medication use. They included a lack of a standard guideline for medication instruction, the inconsistent guidance given by the nurses and pharmacists, and the absence of nurse’s training program in medication use in kidney transplant patients. In addition, there was no medication instruction manual for education purpose and the medication information given by the current instruction was incomplete. Also, we found out that the nursing handover toward medication use was not accurate and the nurses’knowledge of medication use was insufficient. In order to solve these problems, we used a mixed-method design, including establishing a standard guideline for multidisciplinary team, giving a training program in kidney transplant medication to the nursing staff, providing a guidance manual to the nurses for educating patients in medication use, and creating a medication checklist for kidney transplant patients. After implementation, the rate of completeness of nursing staff’s instruction on kidney transplant patient’s medication use increased from 70% to 99% which reached the goal of this project. In conclusion, we could improve patient’s medication safety through the patient-centered common goal established by the multidisciplinary professionals that include doctors, pharmacists, nurses, and coordinators from the transplant team.