運用隨身工具降低某血液透析室病人高血磷之發生率

Using Portable Tools to Reduce the Incidence of Hyperphosphatemic Patients in a Hemodialysis Room

10.3966/172674042017031601002

翁妙妃(Miao-Fei Weng)；黃薇瑾(Wei-Chin Huang)；莊雅筑(Ya-Ju Juang)

血液透析 ； 高血磷 ； 隨身工具 ； hemodialysis ； hyperphosphatemia ； portable tools

臺灣腎臟護理學會雜誌

16卷1期（2017 / 03 / 01）

13 - 26

繁體中文

高血磷之併發症不僅增加醫療成本支出更威脅病人健康及生命，如何改善病人血磷值過高並控制在≦5.5 mg/dl是相當重要。收集2013年10月至2014年3月常規抽血報告發現病人血磷值＞5.5 mg/dl平均每月高達27％∼36％。專案小組旨在降低病人高血磷之發生率。確立問題：護理指導手冊攜帶不便和字體太小、高磷食物種類多、口頭衛教不易記住、食物由家人準備及外食忘記帶藥。改善對策：修訂護理指導手冊、製作影音多媒體衛教影片；設計病人隨身工具：磷結合劑隨身瓶、高磷食物鑰匙圈及聯想圖。實施後病人血磷值＞5.5 mg/dl平均比率由29.1％降至17.9％。專案成效維持，不僅控制病人血磷值也提升護理照護品質。

Complications of hyperphosphatemia not only increase medical costs but also threaten the life and health of patients; it is therefore crucial to reduce elevated serum phosphate levels in patients and keep it below ≦5.5 mg/dl. Results of routine patient blood tests between October 2013 and March 2014 showed that the percentage of patients with serum phosphate levels above 5.5 mg/dl was as high as 27%~36% every month. The goal of the project team was to reduce the incidence of hyperphosphatemia. Issue identification: The nursing manual is cumbersome to carry with fonts that are too small to read; the types of foods with high phosphate levels varied greatly, and oral health education was difficult to memorize; food prepared by family members and forgetting to bring medications when eating out. Improvement strategies: The nursing manual was revised and multimedia health education videos produced; portable tools were designed for patients such as bottles for the phosphate binder that can be carried anywhere, key chains listing foods high in phosphorus, as well as diagrams to help with memorization. Upon implementation, the incidence of patient serum phosphate levels above 5.5 mg/dl dropped from 29.1% to 17.9%. The strategy not only helped to control patients' serum phosphate levels but also improved quality of care as well.

1. Askar, A. M.(2015).Hyperphosphatemia: The hidden Killer in chronic kidney disease.Saudi Medical Journal,36(1),13-19.
2. Daugirdas, J. T.,Blake, P. G.,Ing, T. S.,陳鴻鈞（譯）,陳忠祺（譯）,陳冠樺（譯）(2007).透析手冊.台北:力大.
3. Kalantar-Zadeh, K.(2013).Patient education for phosphorus management in chronic kidney disease.Patient Preference and Adherence,7,379-390.
4. Olauson, H.,Vervloet, M. G.,Cozzolino, M.,Massy, Z. A.,Torres, P. U.,Larsson, T. E.(2014).New insights into the FGF23-Klotho axis.Seminars in nephrology,34(6),586-597.
5. 吳紅蓮,楊麗芬,許薳尹,王郁薇,周雪琦,徐瑋婷(2010)。慢性腎臟病控制高血磷的飲食知識與衛教技巧。腎臟與透析，22(3)，206-209。
6. 莊宇慧(1997)。老年護理的衛教策略。護理雜誌，44(2)，93-97。
7. 陳妙佩,陳建文,蕭善良,毛鴻忠(2012)。長期血液透析病患鈣磷控制與副甲狀腺素濃度的關聯性分析。腎臟與透析，24(1)，54-58。
8. 黃文德,朱柏齡,許育瑞(2014)。磷結合劑在慢性腎臟疾病病人運用的新發展。內科學誌，25(3)，184-194。
9. 楊春紀,黃雯嵐,黃瑞蘭,馬瑞菊(2009)。提升血液透析病人血磷控制成效之專案。馬偕護理管理雜誌，3(2)，37-46。
10. 劉秀芬,葉秀棉,廖小雅(2010)。血液透析病人高血磷護理指導改善專案。澄清醫護管理雜誌，6(4)，58-66。
11. 衛生福利部中央健康保險署（2014）．全民健康保險重大傷病證明有效領證統計表．取自 http://www.nhi.gov.tw/Resource/webdata/15049_2_10305 重大傷病.pdf

1. 劉玉惠,忻蘭,江秀文(2022)。運用多元教學模式降低透析病人高血磷比率。領導護理，23(4)，181-196。
2. 詹佩蓉,石佳娟(2020)。照護一位末期腎臟病病患初次接受血液透析之護理經驗。臺灣腎臟護理學會雜誌，19(1)，64-76。