運用多元策略提升肝臟移植術後病人用藥認知

Using Multiple Strategies to Improve Medication Cognition in Patients After Liver Transplantation

10.6224/JN.202408_71(4).11

蔡宜靜(Yi-Jing TSAI)；黃婕妤(Jie-Yu HUANG)；林欣慧(Hsin-Huei LIN)；劉淑倩(Shu-Chien LIU)；江秋怡(Chiu-Yi CHIANG)；王美文(Mei-Wen WANG)

多元策略 ； 用藥認知 ； 肝臟移植術後 ； multiple strategies ； medication cognition ； post liver transplantation

護理雜誌

71卷4期（2024 / 08 / 01）

89 - 97

繁體中文;英文

背景：接受肝臟移植術後病人須終身服用免疫抑制劑藥物來維持植入新器官功能，臨床調查，接受肝臟移植術後病人回診時發現有藥量剩餘或不足等情形，進而發現對移植術後用藥認知低。分析原因有：術後身體狀態影響學習成效；無持續評值監控肝臟移植術後病人藥物認知機制；衛教指導工具不夠完善及未符合病人需求。目的：肝臟移植術後病人用藥認知正確率由改善前68.3%提升至91%以上；肝臟移植術後病人用藥指導滿意度由改善前63.0%提升至85%以上。解決方案：介入措施包括：設計肝臟移植藥物衛教單張「幸福來的肝肝好用藥日誌」、藥物創意口訣與影片、互動式動畫認知及測試、擬定肝移植病人藥物認知監測機制等措施。結果：肝臟移植術後病人藥物認知正確率由68.3%提升至92.5%及對藥物衛教滿意度由63.0%提升至87.2%。結論：藉由多元策略的衛教方法，來提升肝臟移植術後病人用藥認知，亦在病人用藥安全上更顯護理卓越性。

Background & Problems: Patients with liver transplantation must take lifelong immunosuppressant medication to maintain the function of their hepatic graft. Based on clinical experience, we found that these patients were affected by both insufficient and remaining medication when they returned for outpatient service visits. After investigating the current situation, It was found that post-transplantation perceptions regarding medication were low in this patient group. After analysis, the identified causes of this included: (1) poor learning effect due to the interference from the multiple therapeutic catheter placement postoperatively; (2) delayed timing of assessing the awareness of information or perception of medication and lack of a post-operative follow-up mechanism; and (3) insufficient educational tools and materials for patients. Purposes: This study was designed to increase medication awareness from the current average of 68.3% to > 91% and to increase patient satisfaction with medication guidance from the current 63.0% to > 85% in patients who had received liver transplantation. Resolutions: The improvement strategy included: designing a health education sheet including related medication information and a daily medication record; designing a mnemonic, interactive video, or test to improve medication perception; creating measures associated with a monitor mechanism to assess medication knowledge. Results: After strategy implementation, medication awareness increased from 68.3% to 92.5% and satisfaction with medication guidance increased from 63.0% to 87.2%. Conclusions: The implementation of several strategies concurrently can enhance medication awareness in patients after liver transplantation and increase patient satisfaction with medication guidance.

1. 吳嘉真、黃國珍（2018）．年齡因素與刺激色彩及刺激數量對高齡者短期記憶之影響．福祉科技與服務管理學刊，6（2），163–178。[Wu, C.-C., & Huang, K.-C. (2018). Effects of age, stimuli color, and number of stimuli on short-term memory in the elderly. Journal of Gerontechnology and Service Management, 6(2), 163–178.] https://doi.org/10.6283/JOCSG.201807_6(2).163
   連結：
2. 施靜妤、林玟玲、陳育傑、方信元（2020）．器官移植病人之臨床藥事照護：以肺臟移植病人為例．臺灣臨床藥學雜誌，28（1），61–69。[Shih, C.-Y., Lin, W.-L., Chen, Y.-C., & Fang, H.-Y. (2020). Clinical pharmacy services in organ transplant recipients: Taking lung transplant recipient as an example. Formosa Journal of Clinical Pharmacy, 28(1), 61–69.] https://doi.org/10.6168/FJCP.202001_28(1).0008
   連結：
3. 張家瑜、蔡秀華、蕭鵬卿、高啟雯（2021）．探討使用肝臟移植健康自我管理行動程式對於換肝術後病人健康自主管理能力之成效．源遠護理，15（1），40–50。[Chang, C.-Y., Tsai, H. H., Hsiao, P.-C., & Kao, C.-W. (2021). Mobile health application on self-management of health on post liver transplant. Yuan-Yuan Nursing, 15(1), 40–50.] https://doi.org/10.6530/YYN.202103_15(1).0006
   連結：
4. 黃玉惠、黃玉君、林麗鳳（2018）．應用健康信念模式探討高血壓病人服藥遵從性．榮總護理，35（3），289–301。[Huang, Y.-H., Huang, Y.-C., & Lin, L.-F. (2021). Applying a health belief model to explore adherence among patients with hypertension. VGH Nursing, 35(3), 289–301.] https://doi.org/10.6142/VGHN.201809_35(3).0008
   連結：
5. 廖淑惠（2019）．科學史影片融入教學對學習動機的影響．師友雙月刊，（614），34–38。[Liao, S.-H. (2019). The influence on learning motivation of integrating videos on the history of science into teaching. The Educator Bimonthly, (614), 34–38.] https://doi.org/10.6437/TEB.201908_(614).0007
   連結：
6. 蔡卉婧、張浤榮、連榮達（2018）．服藥順從性對腎臟移植患者腎功能的影響．腎臟與透析，30（1），30–33。[Tsai, H.-C., Chang, H.-R., & Lian, J.-D. (2018). The impact of medication adherence on allograft function in kidney transplant patients. Kidney and Dialysis, 30(1), 30–33.] https://doi.org/10.6340/KD.201803_30(1).0007
   連結：
7. Becker, J. H., Shemesh, E., Shenoy, A., Posillico, A., Knight, C. S., Kim, S.-K., Florman, S. S., Schiano, T., & Annunziato, R. A. (2021). The utility of a pre-transplant psychosocial evaluation in predicting post-liver transplant outcomes. Progress in Transplantation, 31(1), 4–12. https://doi.org/10.1177/1526924820978605
   連結：
8. Bendersky, V. A., Saha, A., Sidoti, C. N., Ferzola, A., Downey, M., Ruck, J. M., Vanterpool, K. B., Young, L., Shegelman, A., Segev, D. L., & Levan, M. L. (2023). Factors impacting the medication “adherence landscape” for transplant patients. Clinical Transplantation, 37(6), Article e14962. https://doi.org/10.1111/ctr.14962
   連結：
9. Hartono, J. L., Koh, T., Lee, G. H., Tan, P. S., Muthiah, M., Aw, M. M., Madhavan, K., Kow, A., & Lim, K. B. L. (2017). Predictors of non-adherence to immunosuppressive therapy in Asian liver transplant recipients. Transplantation Proceedings, 49(6), 1419–1424. https://doi.org/10.1016/j.transproceed.2017.02.049
   連結：
10. Lounsbury, N., Chow, N. K., Jackson, K. C., & Chbib, C. (2022). Creation and implementation of a drug discovery and development game. Currents in Pharmacy Teaching and Learning, 14(2), 229–234. https://doi.org/10.1016/j.cptl.2021.11.025
    連結：
11. Mohamed, M., Soliman, K., Pullalarevu, R., Kamel, M., Srinivas, T., Taber, D., & Posadas Salas, M. A. (2021). Non-adherence to appointments is a strong predictor of medication non-adherence and outcomes in kidney transplant recipients. The American Journal of the Medical Sciences, 362(4), 381–386. https://doi.org/10.1016/j.amjms.2021.05.011
    連結：
12. 衛生福利部（2021，6月18日）．109年國人死因統計結果。 [Ministry of Health and Welfare, Taiwan, ROC. (2021, June 18). Cause of death of statistics, 2020.] https://www.mohw.gov.tw/cp-5017-61533-1.html
13. 衛生福利部（2022，7月14日）．111–112年度醫院醫療品質及病人安全工作目標．台灣病人安全資訊網。[Ministry of Health and Welfare, Taiwan, ROC. (2022, July 14). 2022–2023 hospital medical quality and patient safety goals. Taiwan Patient Safety Net.] https://bit.ly/48AqnmC
14. 蕭淑嫺（2019）．圖像聯想口訣記憶－創意教學之腦力「肌」盪．志為護理－慈濟護理雜誌，18（6），30–31。[Hsiao, S.-H. (2019). Image & slogan memorizing tools for muscle power evaluation. Tzu Chi Nursing Journal, 18(6), 30–31.]