運用自我管理策略控制血液透析病人透析間體重增加之改善方案

Applying Self-Management Strategies to the Control of Interdialytic Weight Gain in Hemodialysis Patients

背景：血液透析病人控制透析間體重增加是維持透析品質的關鍵，但現況調查呈現病人對此議題無動機、自制力差，未養成限制水分與量體重的習慣，及輕忽控制透析間體重的重要性；護理人員執行透析間體重控制護理指導完整率僅61.6％；加上護理指導單張重複性高且缺乏圖片輔助，導致本單位透析間體重增加≥乾體重5％之病人數達48.6％。目的：降低血液透析病人透析間體重增加≥乾體重5％之人數由48.6％降至29.2％。解決方案：2019年8月1日至2020年5月31日實施改善方案，包含：（1）資訊系統新增透析間體重增加計算與提醒功能；（2）製作透析間體重控制護理指導工具；（3）運用自我管理策略建置透析間體重控制照護作業；（4）辦理團體衛教、腎友座談會與在職教育課程；（5）實施透析間體重控制護理指導稽核。結果：透析間體重增加≥乾體重5％之病人數下降至28.8％，透析過程發生急性合併症由42人降為15人（35.7％）。結論：本專案藉由制定透析間體重控制照護標準流程，設計自我管理紀錄表，落實透析間體重控制護理指導，有效降低病人透析間體重增加，期能維持透析品質、降低透析合併症。

Background & Problems: The control of interdialytic weight gain (IDWG) in hemodialysis patients is crucial for maintaining dialysis quality. The results of a survey in our department revealed patients to be unmotivated, have poor self-control, not regularly manage their fluid intake or measure their body weight, and discount the importance of controlling IDWG. The nursing instruction adherence for IDWG control among nurses was only 61.6%. Moreover, the leaflet used for nursing instruction used highly repetitive messaging and lacked pictorial aids. Consequently, up to 48.6% of the patients in our department had an IDWG dry weight percentage of ≥ 5%. Purpose: To reduce the proportion of hemodialysis patients with an IDWG dry weight percentage of ≥ 5% from the current 48.6% to 29.2%. Resolution: From August 1, 2019 to May 31, 2020, the improvement program developed in this project included: (1) the addition of an IDWG calculation and reminder function in the information system; (2) development of nursing instruction tools for IDWG control; (3) utilization of self-management strategies to establish care operations for IDWG control; (4) the organization of group health education sessions, dialysis patient seminars, and on-the-job training sessions; and (5) implementation of an audit program for IDWG-control nursing instruction. Results: The proportion of patients with an IDWG dry weight percentage of ≥ 5% decreased to 28.8% and the number of patients who developed acute complications during dialysis decreased from 42 to 15 (35.7%). Conclusion: IDWG in dialysis patients was effectively decreased by establishing a standard operating procedure for IDWG control, designing a self-management record form, and implementing nursing instruction for IDWG control. It is hoped that the adopted measures promote dialysis quality and reduce complications during dialysis.