運用HFMEA手法提升血液透析新病人飲食認知正確率

Improvement of dietary concept accuracy rate in new hemodialysis patients by HFMEA

收案分析130位末期腎衰竭接受常規血液透析治療的新病人，其營養飲食衛教正確認知率只有55%，新病人常因飲食控制不當造成高血鉀與水份控制欠佳等而危及生命，因此我們運用HFMEA（Healthcare Failure Mode and Effect Analysis）行動改善方案將營養飲食衛教的流程改善及標準化，成立跨部門推動小組將資訊系統整合實施衛教e化作業，營養狀況認知（如血色素與白蛋白）及飲食認知正確率由原來55％增加到97％；高血鉀的危害指數（RPN）由16分降為8分，水份控制不佳危害指數由16分降為4分，營養不良造成合併症危害指數由9分降為3分；此專案藉由HFMEA的技能應用與導入，以e化之衛教作業系統持續且全面掌握新病人飲食衛教的認知差異，並及時予以導正進而改善血液透析品質，達到讓病人安心、照護者放心的全人照護與絕佳的透析品質。

The rate of accurate dietary concept in hemodialysis patients was 55% in ourprevious surveillance Healthcare Failure Mode and Effect Analysis (HFMEA) wasthus introduced to improve the efficacy of diet intervention in HD patients. A totalof 130 new HD patients were recruited. The content included standardized dietaryeducational program and implementation of e-learning system. The results revealedaccuracy rate increased from 55% to 97% The risk priority number (RPN) ofhyperkalemia decreased from 16 to 8; RPN of fluid overload decreased from 16 to4 and it was from 9 to 3 in malnutrition. We concluded that with the introduction ofHFMEA in association with informatization of dietary education system, diet educationwas provided precisely and clinical outcome of hemodialysis patients were improved.