提升頭頸食道癌手術病人之再餵食症候群照護品質

Quality Improvement of Refeeding Syndrome Care in Surgical Patients with Head and Neck or Esophageal Cancer

目的：「安全就醫，全面品管」是醫院臨床照護的基本原則。本文旨在透過優化營養資訊系統進行再餵食症候群風險之自動篩檢與完整醫囑的介入，以達到預防再餵食症候群的成效與提升照護品質。

方法：以國際再餵食症候群風險因子指引與分級優化既有營養篩檢系統，經醫療團隊共識後設置套裝醫囑以及標準化交班流程、宣導教材，進行改善前後資料之分析。

結果：「醫護人員發現率」從改善前49.2 %提升至81.8%，「營養師訪視前的相關醫囑介入率」從改善前63.1 %提升至90.9 %，營養介入後所有電解質皆正常的比率由改善前的21.5 %提升至改善後的45.5 %。

結論：透過優化再餵食症候群營養照護流程，建立全國首創的再餵食症候群營養篩檢系統，降低再餵食症候群的風險，超前部署達到預防勝於治療的成效與臨床營養的照護品質。

 

“Safe healthcare and comprehensive quality control” is a core principle of hospital clinical care. This project aimed to improve the quality of care by optimizing the nutritional information system to enable automatic screening of refeeding syndrome (RFS) risk and the implementation of comprehensive medical orders for prevention. Based on international guidelines for RFS risk factors and stratification, the existing nutritional screening system was enhanced. Following consensus within the medical team, standardized order sets, handover procedures, and educational materials were developed, and a comparative analysis of data before and after the intervention was conducted. Results showed that the RFS detection rate by healthcare professionals increased from 49.2% to 81.8%, and the rate of medical order interventions prior to dietitian consultation increased from 63.1% to 90.9%. The proportion of patients with normalized electrolyte levels after nutritional intervention improved from 21.5% to 45.5%. By optimizing the nutritional care process for RFS, this project established the nation’s first automated RFS screening system, reducing the risk of RFS and achieving the goal of prevention over treatment, thereby enhancing the overall quality of clinical nutrition care.