運用輔助工具改善血液透析病人血磷值達成率專案

Project on Using Auxiliary Tools to Improve Serum Phosphate Goals of Hemodialysis Patients

10.3966/172674042019121802002

劉曉慧(Hsiao-Hui Liu)；陳瑞芬(Jui-Fen Chen)；鄭小蕙(Hsiao-Hui Cheng)；宋振美(Chen-Mei Sung)；楊芝齡(Chih-Ling Yang)；伍碧霞(Pi-Hsia Wu)

輔助工具 ； 血液透析 ； 血磷值達成率 ； auxiliary tools ； hemodialysis ； serum phosphate goal attainment rate

臺灣腎臟護理學會雜誌

18卷2期（2019 / 12 / 01）

13 - 27

繁體中文

本專案旨在改善病人的血磷值，提升血液透析病人血磷值達成率。調查統計2016年7月至11月期間，平均每月血磷值達成率為66.1%，未達到本單位設定的血磷值達成率照護閾值70%。分析、確立問題：忘記用藥或帶藥、純文字護理指導單張、衛教內容較難記住、用藥方式錯誤、食物由照顧者準備等，因此運用輔助工具的介入措施來改善：（1）改良護理指導單張、（2）製作高血磷衛教海報、（3）設計高磷飲食禁忌卡、（4）製作彩色便利貼、（5）製作隨身小藥盒等方案。專案推動後，2017年7月至11月的平均每月血磷值達成率為73.2%，進步率為10.7%。經由製作、運用輔助工具讓病人認知重建、行為修正來提醒自己控制含磷飲食與提高用藥遵從性，有效降低病人的血磷值，進而提升護理照護品質。

This project aims to improve serum phosphate levels in patients, and to improve the attainment rates for serum phosphate goals in hemodialysis patients. An investigation calculated that the average monthly attainment rate for serum phosphate goals from July to November 2016 was 66.1%, which did not achieve the threshold value of 70% for serum phosphate goals set by our unit. We analyzed and established the following problems: forgetting to administer or carry medication, text-only nursing guidance leaflets, difficulty in remembering health education content, mistakes in medication administration, and preparation of food by caregivers. Auxiliary tools were used as an intervention measure to: (1) Improve nursing guidance leaflets; (2) Create health education posters on hyperphosphatemia; (3) Design dietary contraindication card for high phosphate-containing foods (4) Create colorful post-its; and (5) Create mobile medication boxes. After appropriate interventions, the average monthly attainment rate for serum phosphate goals was 73.2% from July to November 2017, and the general progress rate was 10.7%. Through creating and using auxiliary tools for cognitive restructuring and behavioral modification in patients so they can remind themselves to control the intake of phosphate-containing foods and increase medication compliance. This effectively decreased serum phosphate levels in patients, and thereby improved nursing care quality.

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