- 期刊
降低神經毒性化療藥物引起周邊神經病變改善專案
Improvement of Peripheral Neuropathy Caused by Chemotherapy Drugs to Reduce Neurotoxicity
摘要
化學治療所引起的周邊神經病變（chemotherapy-induced peripheral neuropathy, CIPN）是使用taxanes、platinum及vinca alkaloids類化學治療藥物引起的副作用，除了造成病人的不適外，也影響了生活品質。經本病房現況分析發現有以下原因：1.病人對周邊神經病變照護的認知不足；2.缺乏周邊神經病變相關之評估工具，導致病人在面對周邊末梢病變所帶來的不適症狀時，因缺少正確的照護認知而錯失最佳的處置機會。本專案目的為降低神經毒性化療藥物引起周邊神經病變，減輕因神經毒性化學治療的不適症狀影響生活品質。調查護理人員對周邊神經病變照護認知率81%、衛教完整率81.5%；病人對周邊神經病變照護認知率62%；設備缺乏合宜衛教工具；政策面忽略衛教重要性、無規範衛教內容。因此專案解決方案制定衛教流程三部曲，含衛教指導多媒體影音檔、手冊、小卡及在職教育訓練。此為腫瘤照護相關的改善專案，實施專案改善後護理人員的衛教完整率提升至100%、周邊神經照護認知率提升至98%；病人周邊神經照護認知率提升至90%；而使用神經毒性化療藥物引起周邊神經病變由68.5%下降至27%，此專案可作為腫瘤科病房推廣神經毒性化學治療給藥前的衛教作業標準之參考。將此專案解決方案列入新進人員專科在職教育訓練中及整合E化教學平台，提供專科性護理人員臨床照護指引，評值2020年1月至2021年6月新進人員認知評值結果由前測58.3%提升為95%； 2020年6月至2021年7月接受神經毒性化療藥物治療病人，評值周邊神經病變發生率約25%（62／320），其中顯示18位病人神經毒性程度等級為D級，經醫師評估其因糖尿病神經病變故加重周邊神經病變發生，並給予症狀控制，其餘44位病人神經毒性程度等級為C級，但不影響活動與日常生活。故專案改善的策略可有效預防周邊神經病變發生率，其評值成效如專案數據統計所呈現，能協助醫療照護成員在症狀評估和處理方式的作業標準，進而降低化學治療引起之周邊神經病變對癌症病人的衝擊，有效預防周邊神經病變發生率。
並列摘要
Chemotherapy-induced peripheral neuropathy is a side effect resulted from the use of chemotherapy medicines within the taxanes, platinum, and vinca alkaloids categories. Aside from causing discomfort to patients, it also affects the quality of life (Wu, Wang 2016; Zheng, Wang, 2016; Mayans & Mayans, 2015). The following factors were identified based on the analysis of the current conditions of the ward: 1. Patients' insufficient knowledge regarding the care instructions for chemotherapy-induced peripheral neuropathy; and 2. Inadequate evaluation tools for chemotherapy-induced peripheral neuropathy. Therefore, when facing the discomfort brought on by the chemotherapy-induced peripheral neuropathy, patients may miss the window for best opportunity for symptom management on account of the lack of accurate knowledge of care. The purpose of this project is to reduce the chemotherapy-induced peripheral neuropathy related to the medicines for neurotoxic chemotherapy, minimize the effects of discomfort resulted from neurotoxic chemotherapy. Based on the survey, the nursing staff has a perception rate of 81% regarding the care for patients with chemotherapy-induced peripheral neuropathy and a health education integrated rate of 81.5%; patients have a percpetion rate of 62% regarding the care for chemotherapy-induced peripheral neuropathy; there are insufficient appropriate health education tools concerning equipment; in the policy aspect, the importance of health education is neglected, and there is no regulated content for health education. Therefore, this project established a three-phase solution for the health education procedures, including health education guideline multi-media video, handbook, small card, and on-the-job educational training. After the implementation, the nursing staff's health education integrated rate increased to 100%, and the perception rate regarding the care for chemotherapy-induced peripheral neuropathy increased to 98%; patients' perception rate regarding the care for chemotherapy-induced peripheral neuropathy increased to 90%; the occurrence rate of chemotherapy-induced peripheral neuropathy resulted from the medicines for neurotoxic chemotherapy reduced from 68.5% to 27%. Therefore, the project may serve as a reference for the health education standard operations before drug administration under the neurotoxic chemotherapy on the oncology ward.
參考文獻
延伸閱讀
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