改善居家化療病人使用攜帶式輸液器之自我照護認知專案

A Project to Improve Self-Care Knowledge of Home Care Patients Using Portable Infusion Pump Chemotherapy

蔡宜蓁(Yi-Tseng Tsai) ； 吳金璇(Chin-Hsuan Wu) ； 丁妃伶(Fei-Ling Ting) ； 陳淑真(Shu-Chen Chen) ； 呂佩珍(Pei-Chien Lu) ； 黃珊(Shan Huang) ； 梁蕙芳(Hwey-Fang Liang)

《腫瘤護理雜誌》 12卷1期 (2012/06) Pp. 31-44

https://doi.org/10.6880/TJON.201206_12(1).04

摘要

本專案目的為改善居家化療病人使用攜帶式輸液器之自我照護認知率，減少化療藥物外滲，提升對醫療服務品質滿意度。腫瘤醫學演化至今，考量病人兼顧家庭與工作需求，運用科技開創攜帶式輸液器後，將住院化學治療衍生至居家化療，大幅提升病人自主性及便利性。但本院調查發現於2009年發生居家化療藥物外滲者有2人（0.17%），且因延誤就醫而造成皮膚之傷害，因此引發本專案研討動機。經問卷調查發現使用攜帶式輸液器病人返家後之自我照護認知僅66%。分析原因為護理人員方面衛教時間短、內容不易理解；病人方面因年紀大，不識字居多數；工具方面無提供適當之標準衛教手冊及工具；政策面則無制定衛教標準流程及追蹤制度。其解決之道為訂定標準衛教流程及電訪追蹤制度，提供雙語多媒體影音光碟重複播放，製作衛教手冊及衛教小卡。實施改善方法後使用攜帶式輸液器病人返家後之自我照護認知率提升至98.8%，電訪關懷追蹤滿意度提升至4.9%，外滲發生率降至0%，對居家化療病人返家後自我照護能力有顯著成效。

關鍵字

居家化療 ； 攜帶式輸液器 ； 自我照護認知 ； 多媒體影音

並列摘要

The purpose of this project was to improve the self-care knowledge in those patients who received home care chemotherapy by using portable infusion pump. The project was also to decrease extravasation of the chemotherapy, and improve the patients' satisfactions with the quality of the health care services. As the evolution of oncology, the use of scientific technology to make it possible that home care chemotherapy substitutes for the hospitalized chemotherapy. The use of home care chemotherapy took into account the patient and his/her family's needs, and greatly increased the patient's autonomy and convenience. However, according to the hospital investigation in 2009, 2 patients (0.17%) had chemotherapy medicine extravasation and caused skin damages, because of delaying medical care. The incidence of the medicine extravasation motivated us to do the project. Our pilot survey suggested that patients' knowledge of using portable infusion pump for home care chemotherapy was only 66%. According to this survey, the low rate of home care chemotherapy was due to the following reasons: (1) nurses did not have enough time to teach; (2) the contents of teaching materials were too hard to understand; (3) most patients were elderly people, who had not received enough education to understand the contents; (4) there were lacks of standardized teaching pamphlets, and proper tools; (5) there was no standard process and follow-up strategies. To solve the problems, we set up the following strategies: establishing a standardized protocol to operate the portable infusion pump, preparing pamphlets and bilingual multimedia CDs of the health education and self care procedures, providing 24-hour follow-up and consultation phone services to meet the patients' needs. The project results suggested that the patients' self-care knowledge increased to 98.8%. The satisfaction with the phone services in a 5-point scale increased to 4.9%. The rate of medicine extravasation decreased to 0%. The project showed great improvement in self care knowledge in patients who used home care chemotherapy infusion pump.

並列關鍵字

home care chemotherapy ； portable infusion pump ； self-care knowledge ； multimedia CD