運用多元教學模式降低透析病人高血磷比率

本單位為區域教學醫院血液透析室，統計2018年4-6月病人血清磷值大於6.0mg/dL比率為25.5%，高於腎臟醫學會建議比率20%，本專案目的為降低透析病人高血磷發生比率，分析透析病人高血磷發生比率增加的原因：無法正確說出高血磷食物種類、合併症及未正確服用鈣磷結合劑；護理人員未確實執行護理衛教且內容無一致性。針對上述問題擬定改善對策包括：規劃病人高血磷團體衛教課程和護理人員教育訓練、製作高磷「紅綠燈」食物卡、高血磷護理指導光碟及海報、設計和製作攜帶式小藥盒等方法，經由改善方案實施後透析病人高血磷比率由25.5%下降至19.5%，目標達成率109%。本專案發現運用有效的方法與政策的推動，有效降低血液透析病人的血磷值，進而提升透析品質及優質的護理服務。

關鍵字

多元教學模式；透析病人；高血磷

並列摘要

This unit is a hemodialysis room of a regional teaching hospital. According to statistics, the ratio of patients with serum phosphorus values greater than 6.0 mg/dL from April to June 2018 was 25.5%, which was 20% higher than the ratio recommended by the Society of Nephrology. The purpose of this project is to reduce the occurrence rate of hyperphosphatemia in dialysis patients. We analyzed the reasons for the increased incidences of hyperphosphatemia in dialysis patients include: the patients were unable to correctly name the types of foods with high phosphorus level, comorbidities of hyperphosphatemia, and incorrectly taking calcium and phosphorus binders; the nursing staff did not actually implement nursing education and the content was inconsistent. In response to the above issues, the improvement measures were proposed include: planning group health education courses for patients with hyperphosphatemia, educating and training for nursing staff, producing ＂traffic light＂ food cards with high phosphorus level, high-phosphorus nursing guidance CDs and posters; designing and producing small portable medicine boxes and so on. After the implementation of the improvement plan, the rate of hyperphosphatemia in dialysis patients decreased from 25.5% to 19.5%, and the target achievement rate was 109%. This project found utilizing effective methods and policy promotion can effectively reduce the blood phosphorus level of hemodialysis patients, thereby improving the quality of dialysis and enhance high-quality nursing services.

並列關鍵字

multiple teaching models ； dialysis patients ； hyperphosphatemia

參考文獻

卓秋萍、張乃彬、黃寶慧、黃惠暄（2017）．運用圖像記憶法降低血液透析病人之高血磷專案．臺灣腎臟護理學會雜誌，16(2)，1-14。https://doi.org/10.3966/172674042017061602001

姜金伶、梁靖苓、林千如、莊雪芳、王素琴（2016）．提升血液透析病人血磷監測值達成率專案．臺灣腎臟護理學會雜誌，14(1)，19-32 。 http://doi.org/10.3966/172674042015031401002

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陳秀惠、許碧月、簡美惠、劉翠瑤（2015）．降低血液透析病人之高血磷專案．臺灣腎臟護理學會雜誌， 14(3) ， 1-16 。 https://doi.org/10.3966/172674042015091403001

劉心怡、孫閫範、黃瀞萱、黃千郁、賴美玉（2017）．運用衛教指導技巧提升腹膜透析病人血磷控制之成效．臺灣腎臟護理學會雜誌，16(1)，42-55。http://doi.org/10.3966/172674042017031601004

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