運用多元策略降低門診血液透析病人高血磷之發生率

Applying Multiple Strategies to Reduce the Incidence of Hyperphosphatemia in Outpatient Hemodialysis Patients

血液透析病人之高血磷與併發心血管疾病及死亡率息息相關，統計本單位2021年1〜6月門診血液透析病人血磷值≧6 mg/dl平均發生率為32.78%，遠超過腎臟醫學會建議標準20％，引發本專案動機。經現況分析後，其主要原因為病人對高血磷預防認知不足、護理人員對高血磷衛教指導不完整、衛教指導工具不足。故於2021年09月開始實施對策：創新護理指導手冊、製作提醒標語、攜帶式小藥盒、舉辦腎友血磷值進步排行榜、團體衛教、護理人員在職教育、播放高血磷衛教動畫影片、張貼外籍文紅黃綠燈食物對照表及降磷藥物海報等。專案實施後本單位門診血液透析病人高血磷發生率由32.78％下降至19.7％，透過此專案執行，除了有效降低透析病人血磷值，更提升護理照護品質。

 

High levels of serum phosphate in people receiving hemodialysis are associated with cardiovascular disease and mortality.From January to June in 2021, the average incidence percentage of blood phosphorus value ≧6 mg/dl in outpatient hemodialysis patients was 32, which exceeded more 20% than the standard recommended by the Nephrology Association. The purpose of this project is to understand the reasons of these increasing cases in our unit. After analyzing the cases, the findings indicate the main reasons are the lack of awareness of patients on the prevention of hyperemia, the incomplete guidance of nursing staff on hyperphosphatemia health education, and the insufficient health education for the guidance tools.Therefore, the countermeasures against the problems have been implemented since September in 2021. They are innovative nursing guidance manuals, the production of reminder slogans, portable small pill boxes, the establishment of progress ranking list for kidney patients, the hygiene regulations, the training for nursing staff, the advocacy videos of high blood phosphorus health, the posting posters of red, yellow and traffic light food comparison tables in foreign languages and phosphorus-lowering drugs, etc.After the implementation of the project, the percentage of high blood phosphate in outpatient hemodialysis patients in our unit has decreased from 32.78% to 19.7%. In addition, the quality of nursing care is also improved.