某地區醫院血液透析病患尿素氮移除率之改善專案

Improvement of Urea Reduction Ratio in Hemodialysis Patients in a Regional Hospital

10.3966/172674042018031701003

童美雅(Mei-Ya Tung)；黃麗真(Li-Jane Hung)；劉旆辰(Pei-Chen Liu)；林卉姍(Hui-Shan Lin)；蔡淑美(Shu-Mei Tsai)

血液透析 ； 尿素氮移除率 ； hemodialysis ； urea reduction ratio (URR)

臺灣腎臟護理學會雜誌

17卷1期（2018 / 03 / 01）

29 - 44

繁體中文

本專案旨在改善血液透析病患尿素氮移除率（Urea reduction ratio, URR）之達成率，尿素氮移除率不足易造成病患食慾不佳、皮膚癢、心血管問題，增加住院率及死亡率。根據單位每月上傳照護品質報表中發現，2015年1-3月 URR＞65％達成率僅70-75.9％，確立專案問題為血液透析病患尿素氮移除率之改善專案。經現況分析後，確定導因為：（一）病患層面：兩次透析間體重增加＞乾體重的5％、對URR相關知識不足；（二）護理人員層面：血管通路穿刺部位選擇不適當、未依照病患透析處方設定機器版面；（三）輔助工具層面：單位內缺乏URR不足相關團體衛教、海報及衛教影片，擬定改善策略為：實施體重控制不佳病患水份控制衛教手冊發放、制定血管通路穿刺部位圖及輪序記錄表、舉辦血管通路穿刺技巧在職教育、運用血液透析處方常規作業表、執行兩人雙重核對透析機器版面設定、舉辦團體衛教、選擇時段播放衛教影片並張貼海報。經各項解決策略介入後，病患URR＞65％達成率提升至90.1-91.6％，不僅達成本專案的目標，更提升護理照護品質。

The aim of this project is to improve urea reduction ratio (URR) of achievable rate in hemodialysis patients. Inadequate URR may cause poor appetite, skin itching, cardiovascular disease, increase admission rates and mortality rate. According to the nursing quality report uploaded by the unit every month, the achievement ratio of URR ＞ 65% in January to March 2015 was only 70% to 75.9%. To improve the hemodialysis patients' urea reduction ratio is the aimof this project. After analysiizing the current situation, it was determined that: (1) patient level: The patients' interdialytic weight gain over the 5% dry weight between two dialyses, and insufficient knowledge of URR. (2) Nursing staff level: The vascular puncture site was selected improperly and the machine setting was not according to the patients' dialysis prescription. (3) Auxiliary tool level: There are insufficient knowledge for URR in group education, posters, and teaching videos. The proposed improve strategies were as follows after futher analysis and study: Gave training manual to patients with poor weight control due to absorbing excessive water; formulated an illustration showing the vascular access area to be punchtured and rotation record chart; held ion-the-job training about puncturing skills of vascular access; used hemodialysis prescription routine form; performed a two-person double check on the settings of dialysis machines; to organize group education for patients; and selected a specific time to show teaching videos and posters. After the intervention of above strategies, patients with URR ＞ 65% achievable rate increased to 90.1%~91.6%. Not only was the aim of the project achieved, but also improved the quality of nursing care.

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