改善營養照會流程與提升癌症住院病人營養攝取量之專案

Project for Improving Nutrition care Processes and Nutrient Intake in Hospitalized Cancer Patients

目的：提供癌症治療病人營養照護計畫，積極補充營養是維持良好生活品質之關鍵。建立標準作業流程確實提供化療、放療或手術治療之癌症病人更完整的醫療照護。方法：運用品管手法找出導致癌症住院病人營養照護品質偏低原因，以問卷調查進行真因驗證。原因一、醫療人員認知不足，病人追蹤不易；二、缺少衛教教材；三、營養照護資訊系統不完整。依真因擬定對策：（一）修改癌症會診條件，運用主動式營養照護；（二）建置癌症個管師轉介癌症病人，營養諮詢照護標準作業流程；（三）營養師主動營養關懷，並轉介住院、門診癌症病人營養諮詢門診；（四）新增癌症營養照護資訊系統評估項目；（五）營養師主動於病人出院後做電訪關懷，增設癌症營養諮詢門診。結果：營養照護改善前後數據，癌症病人營養照護率由26.7%提升至76.7%；營養攝取每日總熱量達到75.0%建議量，由改善前43.3%提升至66.6%；營養攝取每日蛋白質達到75.0%建議量，由改善前47.7%提升至63.6%；電訪關懷營養照護成效由追蹤前營養不良60.6%降至18.2%。結論：調整營養照會流程，增加主動營養衛教指導，在提升癌症病人營養攝取量是有相關性的。（澄清醫護管理雜誌2019；15（3）：54-63） Purposes Providing a nutrition care program for patients undergoing cancer treatment and active nutrient supplementation are key to maintaining good patient quality of life. Establishing standard operating procedures will allow the provision of comprehensive medical care for cancer patients undergoing chemotherapy, radiation therapy, or surgery. Methods We employed quality management techniques to identify the reasons for the low quality of nutritional care among hospitalized patients and conducted a questionnaire survey to verify the root causes. The identified reasons included the following: 1. lack of awareness among medical staff and difficulty in patient tracking; 2. lack of teaching materials; and 3. an incomplete nutrition care information system. We formulated the following countermeasures: 1. employment of active nutrition care to modify cancer consultation conditions; 2. Establishment of standard operating procedures for case managers to refer cancer patients for nutrition counseling and care; 3. proactive demonstration of nutrition care and referral of inpatient and outpatient cancer patients to nutrition counseling clinic by nutritionists; 4. development of a new cancer nutrition care information system assessment project; and 5. proactive telephone interviews by nutritionists after patient discharge and establishment of outpatient cancer nutrition counseling clinics. Results Comparison of data collected before and after nutrition care improvements showed that the nutrient care rate of cancer patients increased from 26.7 to 76.7%. The total daily caloric intake reached 75.0% of the recommended amount, and the intake ratio increased from 43.3% to 66.6%. In addition, the daily protein intake reached 75.0% of the recommended amount, which increased from 47.7% to 63.6%. The telephone follow-up of nutrition care revealed that malnutrition had decreased from 60.6% to 18.2%. Conclusions Adjusting nutrition care procedures and increasing active nutrition health education guidance were correlated with improved nutrition intake in hospitalized cancer patients. (Cheng Ching Medical Journal 2019; 15(3): 54-63)