降低住院血液透析病人之透析排程缺失率

Strategies to Reduce the Rate of Dialysis Sessions Being Missed in Hospitalized Patients Undergoing Hemodialysis

10.6142/VGHN.202009_37(3).0004

何玉瑛(Yu-Ying Ho)；陳怡伶(Yi-Ling Chen)；陳永娟(Yong-Chuan Chen)

血液透析 ； 透析排程 ； hemodialysis ； dialysis schedules

榮總護理

37卷3期（2020 / 09 / 01）

252 - 259

繁體中文

住院血液透析病人因病情不穩定，需增減透析次數或改變治療模式與週期，因此透析排程需高度依賴護理人員的聯繫與安排，卻仍容易因人為疏失造成排程錯誤，影響照護品質。本專案目的為降低血液透析病人之透析排程缺失率。經現況分析，透析病人排程缺失率高的原因包括護理人員接收不完整的血液透析醫囑、人工插牌流程繁雜、病房無法得知透析排程、插牌紙張輕薄易掉落等，導致單位血液透析排程缺失率高達14.50%，故引發專案動機。透過建置透析需求醫令及審核機制、安排在職教育、住院病人透析名單資訊化、顯示B、C型肝炎註記及線上即時查詢透析排程等措施，有效降低透析排程缺失率至2.60%，達專案目標，確保住院血液透析病人之照護安全。

An increase or decrease in the number of dialyses and modification of the treatment mode and cycle are frequently required in hospitalized patients undergoing hemodialysis because of their unstable condition. This often results in the dialysis schedule being highly dependent on the communication and arrangement of the nursing staff. However, scheduling errors caused by human oversight are likely to occur. Hospitalized patients undergoing hemodialysis require dialysis treatment according to a strict schedule. Therefore, the purpose of this project was to reduce the frequency of missed dialysis sessions in such patients. By analyzing the current situation, we found that the reasons for a high rate of missed dialysis sessions were incomplete hemodialysis orders received by nursing staff, complex manual insertion procedures, lack of information regarding the dialysis schedule on the ward, and misplaced insertion papers. The rate of hemodialysis sessions being missed was found to be 14.50%, which triggered the urgency of this project. Through establishment of medical order requirements and review mechanisms for dialysis needs, arrangement of on-the-job training, transition of the list of hospitalized patients undergoing dialysis from a paper-based to a digital format, special notation for patients with hepatitis B or C, and online access to real-time dialysis schedules, the missed hemodialysis session rate was reduced to 2.60%. Accomplishment of the project goal ensures safety in the care of hospitalized patients undergoing hemodialysis.

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