改善肝腎移植術後跨團隊照護指導完整性專案

Project for Improving the Integrity of Multidisciplinary Care After Liver and Kidney Transplantation

10.6142/VGHN.202212_39(4).0010

張寧潔(Ning-Chieh Chang)；顏珮鈞(Pei-Chun Yen)；張映晴(Ying-Ching Chang)；王麗玲(Lih-Ling Wang)；鄔恒斐(Heng-Fei Wu)；裘苕莙(Tiao-Chun Chiu)

肝腎移植 ； 移植術後照護 ； 跨團隊合作 ； 照護指導流程圖 ； liver and kidney transplant ； post-transplantation care ； multidisciplinary care ； care guide flowchart

榮總護理

39卷4期（2022 / 12 / 01）

421 - 429

繁體中文

器官移植術後照護資訊繁多，須經由跨團隊醫療成員共同完成照護指導的各項內容。統計2017年4月1日至2018年3月31日，本病房肝腎移植術後跨團隊照護指導完整率為68.5％，遠低於本院閾值（＞95％），故成立專案小組，分析原因有出院前指導訊息繁多、跨團隊橫向聯繫不佳、缺少輔助教具、指導內容無標準化、未制定跨團隊分工職掌規範，且無查核機制。經由推動整合，將跨團隊照護指導內容標準化、同步修訂衛教單張內容、製作藥圖卡及益智互動教材、制訂指導流程圖與工作査檢表等專案改善措施後，將肝腎移植術後跨團隊照護指導完整率提升至96.7％，大幅提升整體照護品質，期能藉由本專案經驗推廣至其他同性質的病房。

Care information should be provided after organ transplantation, and multidisciplinary teams must coordinate to inform patients. According to statistics from April 1, 2017, to March 31, 2018, the rate at which information was provided after liver and kidney transplantation in this ward was 68.5%, far lower than the threshold of our hospital (＞95%). In response, a special team was established. The reasons for this low rate include the high volume of information, the lack of standardization and auxiliary teaching aids, poor horizontal communication among teams, and the lack of an audit mechanism. A standardized care guide flowchart was administered to all teams, health education leaflets were revised, and medicine flashcards and interactive educational materials were developed; these strategies increased the rate to 96.7%, thereby considerably improving nursing care quality. This project can be applied to other wards to achieve similar results.

1. 王家良、楊得政、王守玠、張淑鈺(2016)．換腎洗腎存活率比一比．腎臟與透析，28(1)，1-4。
   連結：
2. 李佳倫、洪志秀(2017)．推動跨領域團隊教育的挑戰和策略．護理雜誌，64(6)，106-111。
   連結：
3. da Silva Knihs, N., de Pádua Lorençoni, B., Pessoa, J. L. E., Paim, S. M. S., Ramos, S. F., da Silva Martins, M., Wachholz, L. F., Bittencourt, I., Fabiane Sebold, L., Nazareth Amante L., Sens, S., Lunardi, F., Santos, J. D., & de Aguiar Roza, B. (2020) Health needs of patients undergoing liver transplant from the context of hospital discharge. Transplantation Proceedings, 52(5), 1344-1349.
   連結：
4. Frank-Bader, M., Beltran, K., & Dojlidko, D. (2011). Improving transplant discharge education using a structured teaching approach. Progress in Transplantation, 21(4), 332-339.
   連結：
5. 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.
   連結：
6. Mangold, K. (2016). Utilization of the simulation environment to practice teach-back with kidney transplant patients. Clinical Simulation in Nursing, 12(12), 532-538.
   連結：
7. Pillai, V. G., & Chen, C. L. (2016). Living donor liver transplantation in Taiwan-challenges beyond surgery. Hepatobiliary Surgery and Nutrition, 5(2), 145-150.
   連結：
8. Pusic, M. V., Ching, K., Yin, H. S., & Kessler, D. (2014). Seven practical principles for improving patient education: Evidence-based ideas from cognition science. Paediatrics and Child Health, 19(3), 119-122.
   連結：
9. Whitham, D., Duley, L., & Erven, A. (2015). Improving quality and efficiency of trial with a novel approach to standard operating procedures (SOPS): Case study from a CTU. Trials, 16(2), 180.
   連結：
10. 張孟玲、邱國琄、高木榮、劉祥得(2016)．護理人員維護病人安全之影響因素探討．北市醫學雜誌，13(3)，123-136。
11. 鄭麗珠、王雪娥、凃秀妮(2020)．免疫系統異常之護理．於劉雪娥總校閱．成人內外科護理(上冊) (八版，547-562頁)．華杏。
12. American Society of Transplantation. (2016). Medicines for keeping your transplanted organ healthy. https://www.myast.org/sites/default/files/Medicines%20for%20Keeping%20Your%20Transplanted%20Organ%20Healthy.pdf
13. Cimino, F. M., & Snyder, K. A. (2016). Primary care of the solid organ transplant recipient. American Family Physician, 93(3), 203-210.