降低血液透析病人體重誤差率之專案

A Project for Reducing the Body Weight Error in Hemodialysis Patients

10.29494/LN.202106_22(2).0008

謝玉婷(Yu-Ting Shie)；賴雅韻(Ya-Yun Lai)；金美華(Mei-Hua Chin)

血液透析 ； 水份排除 ； 體重誤差 ； hemodialysis ； removal of fluids ； body weight error

領導護理

22卷2期（2021 / 06 / 01）

112 - 126

繁體中文

末期腎衰竭病人因腎功能損壞，需仰賴透析排除過多水分及尿毒素，水份的排除一般是以體重的變化為參考依據，因此透析前後正確測量體重及透析前計算病人脫水量是透析照護最重要課題，測量錯誤或計算錯誤而低估、高估體重，會導致體液容積過量或移除過多水份而造成肺水腫、低血壓、肌肉痙攣、動靜脈血管阻塞、休克等嚴重併發症，不但影響病人生命安全，也增加醫療成本，對病人與透析單位都是額外的負擔。單位將「預定透析後體重與實際透析後體重誤差」列為品質指標，2015及2016年平均體重誤差率為1.0%、1.1%，由資料得知其中3件因脫水量不足造成肺水腫入加護病房治療，分析造成誤差原因：1.測量者執行體重測量時操作流程不正確；2.護理人員抄寫、計算體重不確實；3.病人記錯體重數值，報錯數據造成錯誤；4.護理人員設定脫水量依據缺乏統一標準規範；5.病人與護理人員透析前後計算衣物扣重標準不一致。藉由1.制定體重測量標準書、擬定護理作業流程；2.擬定在職教育；3.規劃團體衛教；4.設計體重測量流程海報；5.設計各國版體重測量流程衛教單張；6.規劃體重計黏貼螢光貼、防呆裝置及維護；7.錄製體重測量防呆語音檔等改善措施，誤差率由0.95%降至0.27%，不僅維護病人透析安全，也提升護理照護品質。

Patients with terminal stage renal failure rely on dialysis to remove excessive fluid and urinary toxins due to impaired renal function. The amount of water removal is based on the body weight alteration. Hence, the most important task is to correctly measure the body weight both before and after dialysis, as well as calculating patient's removal of fluids rate before ultrafiltration during ultrafiltration care. Measurement errors or calculation errors as well as underestimation or overestimation of body weight can lead to excessive body fluid volume or excessive water removal, resulting in severe complications such as pulmonary edema, hypotension, muscle spasm, arteriovenous vessel obstruction, shock, and so on. These complications affect the safety of patients, and also increase medical costs, which is an additional burden on both the patients and dialysis units. The unit lists ＂the difference between the scheduled weight after dialysis and the actual weight after dialysis＂ as a quality indicator. The average weight error rate in 2015 and 2016 was 1.0% and 1.1%. According to the data, 3 cases of pulmonary edema due to insufficient dehydration were included in intensive care ward treatment, analysis of the causes of errors are: 1. Formulate weight measurement standards and formulate nursing procedures; 2. Paramedics Nursing staff were not accurate when copying and calculating weight; 3. The patient remembers the wrong body weight and the wrong data report causes an error; 4. The patient's weight was recorded wrong and the nursing staff sets the amount of dehydration based on lack of uniform standards; 5. Inconsistent calculation of clothing deduction standards between patients and nurses before and after dialysis. The inaccuracy rate was reduced from 0.95% to 0.27% by introducing methods such as: Firstly, formulating the criterion of body weight measurement, setting the process of nursing practice; Secondly, conducting in-service education and group health education; Marking weighing scale by fluorescent stickers, designing the poster of measurement steps; Making various version of measurement steps for multiple countries; Finally, improvement measures such as recording weight measurement and foolproof voice files, to prevent patients and nurses from inconsistent calculation of clothing deduction standards before and after dialysis. Besides maintaining the security of the patient during hemodialysis these also promote the nursing care quality.

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