提升血液透析護理人員瘻管功能評估正確率

A Project for Improving the Accuracy in Fistula Function Assessment among Hemodialysis Nurses

動靜脈瘻管功能評估是血液透析護理人員臨床照護上頻率高且重要的專業能力，迅速正確辦別瘻管失能，彰顯護理獨立性功能，進而避免因瘻管失能影響透析品質或臨時插管之醫療處置，提升照護品質。本專案旨在提升血液透析護理人員瘻管功能評估正確率。經由現況分析發現血液透析護理人員瘻管功能評估正確率低可能原因與護理人員瘻管功能評估知識與技能需要加強，缺乏合宜的瘻管功能評估工具。經由成立溝通平台，制定瘻管功能評估標準與評核規範、發展並增設瘻管評估工具，規劃並執行護理人員瘻管評估在職教育活動。專案實施後，瘻管功能評估正確率由62.5%提升至86.6%，瘻管功能評估認知得分由63.5 分提升至93.6 分，及早處理瘻管功能異常由31%提升至83.3%。此結果表示提供在職教育、制定臨床作業準則，與常規監測，能有效提升護理人員正確執行率，以及透析病人對瘻管照護之肯定。

 

If nurses can carry out fistula function assessment correctly and distinguish the characteristics of fistula failure clinically, the quality for patients and nurse-patient relationships could be enhanced. This project is intended to improve the correct assessment of fistula functions by the hemodialysis nursing staff. An analysis of status quo revealed that the low accuracy of fistula functional assessment by the hemodialysis nursing staff may be due to a lack of knowledge, skill proficiency and appropriate assessment tools. Therefore, a communication platform and a standard on fistula functional assessment were developed, along with an assessment tool and evaluation guidelines; the nursing staff also participated in occupational training on fistula evaluation. After this project has been implemented, accuracy of fistula functional assessment improved from 62.5% to 86.6%; the fistula assessment awareness score increased from 63.5 to 93.6; the early treatment of fistula abnormality improved from 31% to 83.3%. The results showed that occupational training, clinical operating guidelines and routine monitoring can effectively improve the accuracy of the nursing staff thus gaining acceptance from dialysis patients on the quality of fistula care.