改善血液透析病人高血鉀危急值之通報流程及臨床處置

Improvement of Critical Hyperkalemia Reporting and Management in Chronic Hemodialysis Patients

血液透析病人常發生高血鉀症，若合併其他共病症則容易導致高死亡率；為提升病人對疾病識能及遵從性，降低高血鉀引發的死亡風險，本科自2017年8月至2018年3月期間成立「改善門診血液透析病人高血鉀危急值之通報流程及臨床處置」專案，經現況分析歸納出高血鉀發生原因，導入跨領域團隊合作共同照護、創新個案管理、商店街巡禮、里民關懷、建置臨床處置標準化供人員依循。高血鉀危急值發生率由改善前1.72％降至改善後1.35％；高血鉀認知正確率由65.6％達92.4％；營養師衛教滿意度達95％；因高血鉀需急診就醫人數同時間內由38人減為14人；住院由13人減為10人；透析病人心臟疾病死亡率由0.5％下降至0.2％。我們的結論認為此專案活動有效降低高血鉀發生率，進而提升整體照護品質。

Hyperkalemia is a very common complications observed in chronic hemodialysis patients. Of note, the associated morbidity and mortality is high especially in patients with critical hyperkalemia. We introduced a project during the period from August 2017 to March 2019 to improve the reporting system and clinical management of critical hyperkalemia in hemodialysis patients. Firstly, causes of hyperkalemia were analyzed and then several interventions were administered such as: team resource management (TRM), innovative case management, dietitian round on food shops, care program for patients living alone and standardization of clinical management. The incidence of hyperkalemia was reduced from 1.72% to 1.35%; accuracy rate of patient understanding increased from 65.6% to 92.4%; and satisfaction rate of dietitian education was 95%. The patient number of emergency visit was reduced from 38 to 14 and it was reduced from 13 to 10 for hospitalization. Cardiovascular mortality was also decreased from 0.5 % to 0.2%. In conclusion, by the multi-faceted intervention, critical hyperkalemia in chronic hemodialysis patients was decreased and associated with improvement in care quality.