提升醫－病－護描述血尿程度之一致性

Improving Consistency Among Descriptions of the Degree of Hematuria by Doctors, Patients, and Nurses

10.6142/VGHN.202106_38(2).0009

蔡佩芬(Pei-Fen Tsai)；歐立真(Li-Chen Ou)；簡渝汶(Yu-Wen Chien)；桑潁潁(Yiing-Yiing Sang)；陳怡君(I-Chun Chen)；吳蘭蓀(Lan-Suen Wu)

肉眼血尿 ； 泌尿系統疾病 ； 血尿色卡 ； gross hematuria ； urinary system diseases ； hematuria color card

榮總護理

38卷2期（2021 / 06 / 01）

184 - 193

繁體中文

肉眼血尿是泌尿系統疾病的重要徵象，當徵象惡化時，需要及時通報，以免錯失接受治療的最佳時機，對疾病預後造成負面影響。本單位於2017年10月15日至11月30日，以紀錄內容查詢、問卷調查、觀察法等收集資料，分析發現醫－病－護描述血尿程度之一致性僅51.99%，對疾病判斷及治療決策之影響甚巨，主要導因為：無客觀描述血尿程度之工具及方法、護理指導單張缺乏描述血尿方法及相對應處理資訊、醫護人員無血尿評估相關教育訓練、電話或電腦交班無法直接觀察尿液顏色，經文獻查證及團隊研討，採行製作『血尿色卡』及『血尿辨識方法及處理』護理指導單張、舉辦「醫護人員血尿辨識共識會」、設置血尿色卡應用稽查機制等方法，於2018年1月17日至2018年7月31日實施後，評值醫－病－護描述血尿程度之一致性提升至100%。血尿徵象可能存在於各科疾病，運用客觀的評估工具能準確描述血尿程度，及早提供合宜處置建議，期望未來能推廣應用，讓臨床照護描述血尿程度一致又便利！

Gross hematuria is a key symptom of urologic diseases. When symptoms worsen, the condition must be reported and addressed as early as possible to doctors to avoid patients missing the best time of treatment, because delayed treatment can worsen the prognosis of the disease. Our unit collected data through records, surveys, and observations from October 15, 2017, to November 30, 2017. Our investigation found that the consistency of the description of the degree of hematuria between doctors, patients, and nurses was only 51.99%, which greatly influenced disease judgment and treatment decisions. The investigation determined the following primary causes of inconsistency: no tools and methods were utilized to objectively describe the degree of hematuria; the nursing guidance leaflet lacked a method for describing hematuria and corresponding care information; professionals lacked training or instructions related to hematuria assessment; and professionals had an inability to directly observe the color of urine through telephone or electronic handover. Through research, a literature review, and a group study, we implemented a ＂hematuria color card＂ and a nursing guidance leaflet with ＂methods of identifying hematuria and treatment＂ and we held a meeting to establish a ＂consensus on the identification of hematuria for medical staff＂ and to establish the application inspection mechanism of a hematuria color card. After our implementation from January 17 to July 31, 2018, the consistency of the description of the degree of hematuria among doctors, patients, and nurses increased to 100%. Hematuria may present as a symptom in various diseases. The use of objective assessment tools can accurately describe the degree of hematuria that we encounter and can provide rapid, appropriate treatment suggestions. We hope that our techniques can be promoted and applied in the future for the degree of hematuria to be described consistently and conveniently across clinical care settings.

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