降低血液透析病人高血磷之發生率

Lowering the Incidence of Hyperphosphatemia in Hemodialysis Patients

10.3966/172674042020121902005

張雅評(Ya-Ping Chang)；江永貞(Yung-Chen Chiang)；黃漢琪(Han-Chi Huang)；徐碧秀(Pi-Hsiu Hsu)

血液透析 ； 高血磷 ； 手機APP ； hemodialysis ； hyperphosphatemia ； mobile apps

臺灣腎臟護理學會雜誌

19卷2期（2021 / 01 / 01）

66 - 80

繁體中文

高血磷是血液透析病人最常見的問題，統計本單位2017年7月至12月期間病人血磷值≧6.0 mg/dl者高達23.3∼24.4％，遠超過腎臟醫學會所建議標準20％。專案小組經現況分析後，其主要原因分為兩大部份，病人常見問題：對於高磷食物種類太多記不住、不了解高血磷合併症、忘記攜藥或服藥、不知道正確吃法、且常遺失護理指導單張等；護理人員則為護理指導內容不一致、常因業務忙碌中斷指導、缺乏血液透析疾病及照護新知及未定期舉辦團體護理指導等。故於2018年1月開始實施對策：護理照護指引、舉辦在職教育、創新隨身攜帶小藥瓶、舉辦團體護理指導、使用手機APP及播放高血磷動畫影片、張貼海報等。專案實施後本單位血液透析病人高血磷比率由25.5％下降至18.5％，透過此專案執行，有效降低病人血磷值，更達到提升護理照護品質。

Hyperphosphatemia is the one of most common problems in end-stage renal disease (ESRD) patients on maintenance hemodialysis. From July to December, 2017, there were 23.3% to 24.4% of hemodialysis patients whose serum phosphate values were ≥ 6.0 mg/ dl. The prevalence of hyperphosphatemia is higher than the standard value of 20% set by the Taiwan Society of Nephrology. Then we performed the root cause analysis and found the main problems: too many types of high-phosphorus foods, often confused with high-potassium foods, ignorance of hyperphosphatemia comorbidities, forgetting to take or carry drugs, lost nursing guidance leaflets; inconsistent content of nursing guidance, interruption of nursing guidance due to busy business, Not held group nursing guidance regularly. Thus, multidisciplinary approaches were implemented from January, 2018 as follows: developing nursing care guideline for hyperphosphatemia, holding continuing education programs for nurse and group educations for patients, using easily carry-on pill bottles and creating informative posters, mobile apps and animated videos for dietary phosphate education. After completing this project, the prevalence of hyperphosphatemia hemodialysis patients was declined from 25.5% to 18.5%. This project effectively lowered serum phosphate levels in hemodialysis patients and significantly improved the quality of nursing care for ESRD patients with hyperphosphatemia.

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