降低透析機警報聲發生率之專案

An Improved Project for Reducing the Incidence of Hemodialysis Machine Alarms in a Regional Hospital

血液透析機的正常運作攸關病人安全，而過多的透析機警報聲除反映血液透析期間發生的問題外，亦會成為透析過程中的噪音，造成腎友緊張焦慮，進而降低透析品質，也增加醫護人員工作量。本單位於2019年5月1日至5月31日間，血液透析機警報聲發生率為63.3%，確立專案問題為降低血液透析機警報聲發生率之改善專案。經分析發現原因有血壓過低、靜脈壓力監測夾未打開、血管通路問題。擬定改善策略為：舉辦水份控制團體衛教、製作水份控制宣導海報及魔法包；制定血液透析引血操作護理指導標準流程；舉辦血管通路穿刺技能與知識在職教育及製作血管通路穿刺輪序圖進行穿刺。對策實施後，血液透析機警報聲發生率由63.3%降至23.4%，不僅降低病人的不安與焦慮，也減少護理人員往返處理警報聲之時間，進而讓病人獲得更安寧與舒適的透析環境。

The correct operation of hemodialysis machines is critical for patient safety. However, excessive hemodialysis machine alarms not only reflect patient problems during hemodialysis but also make a noisy environment, leading to patient anxiety and an uncomfortable dialysis environment, thereby increasing the workload of medical and nursing staff. From May 1 to May 31, 2019, the hemodialysis machine alarm rate of this unit was 63.3%; this prompted the current project, which aimed at lowering the hemodialysis machine alarm rate. The analysis identified the causes of hemodialysis machine alarms as hypotension, the venous pressure clamp being closed, and vascular access problems. Accordingly, the following improvement strategies were developed: holding group health education, creating a hydration control propaganda poster and education packages, establishing standard procedures for hemodialysis blood flow operations, holding in-service courses on vascular access puncture techniques and knowledge, and establishing a vascular access puncture sequence diagram for performing a puncture. After implementing these strategies, the hemodialysis machine alarm rate decreased from 63.3% to 23.4%. In addition, patients’uneasiness and anxiety were reduced and the time taken by nursing personnel in responding to hemodialysis machine alarms was lowered. Thus, we provided patients with a more peaceful and comfortable dialysis environment.