運用行為修正策略降低血液透析病人高血鉀發生率之改善專案

A Project to Apply Behavior Modification to Reduce the Incidence of Hyperkalemia in Hemodialysis Patients

林育珊(Yu-Shan Lin) ； 陳國蘭(Guo-Lan Chen) ； 尤宜菁(Yi-Ching Yu) ； 林嘉鈴(Chia-Ling Lin)

《臺灣腎臟護理學會雜誌》 15卷2期 (2016/06) Pp. 21-38

https://doi.org/10.3966/172674042016061502003

摘要

高血鉀為血液透析病人常見且高危險之合併症，本單位於2013年3-8月血清鉀離子≧5.5 mEq/L發生率為27.5％，相較2012年9月至2013年2月15.7％有顯著上升情形。本專案旨在降低血液透析病人高血鉀之發生率。經現況分析歸納出高血鉀發生的原因後，運用行為修正策略製作了低鉀飲食衛教手冊、低鉀食物圖表、飲食及服藥紀錄卡、提醒小卡、病歷標示小卡、定期舉辦團體衛教並張貼海報及製作低鉀 飲食衛教光碟之改善策略。本專案改善措施實施後，血清鉀離子≧ 5.5 mEq/L的發生率由2013年3-8月改善前27.5％降低至2014年1-6月改善後10.5％，達成本專案所設定之目標值12％。藉由行為修正策略建構出一套針對預防高血鉀的照顧模式，有效降低血液透析病人高血鉀之發生率，進而提升血液透析照護品質。

關鍵字

血液透析 ； 高血鉀 ； 行為修正

並列摘要

Hyperkalemia is common complication in hemodialysis patients. According to statistics from this department, an average serum potassium concentration of ≧5.5 mEq/L had an incidence of 27.5% between April and August, 2013. This result was significantly higher than that reported between September, 2012 and February, 2013 (15.7%). The purpose of this project is to reduce the incidence of hyperkalemia in hemodialysis patients. The project was established to determine the cause of this result and to implement Behavior Modification for reducing hyperkalemia. The following initiatives were used to reduce hyperkalemia: low potassium diet education pamphlets, low sodium food chart, diet and medication record card, reminder cards, patient record indication card, regular group health education sessions as well as posters and low potassium diet videos. After the project was implemented, the department's incidence of serum potassium ion ≧5.5 mEq/L declined from 27.5% (March-August, 2013) to 10.5% (January-June, 2014) and met the project target of 12%. The hyperkalemia rate of hemodialysis patients was therefore effectively reduced by implementing a series of behavior modification initiatives and a better quality of care.

並列關鍵字

hemodialysis ； hyperkalemia ； behavior modification

參考文獻

Antonello, P., Matteo, F., Mitchell, H. R., & Clandio, R. (2014). Hyperkalemia in hemodialysis patiens. Seminars in Dialysis, 27(6), 571-576. doi: 10.1111/sdi.12272

Cristina, A., Ana, T., Telma, S., & Cristina, G. (2015). Effect of personalized nutritional counseling in maintenance hemodialysis patients. Hemodialysis International, 19, 412-418. doi: 10.111/hdi.12260

McGrath, B. M., Harmon, J. P., & Bishop, G. (2010). Palmaria palmate (D-ulse) as an unusual maritime aetiology of hyperkalemia in a patient with chronic renal failure: A case report. Journal of Medical Case Reports, 4, 301-303. doi: 10.1186/1752-1947-4-301

Machek, P., Jirka, T., Moissl, U., Chamney, P., & Wabel, P. (2010). Guided optimization of fluid status in hemodialysis patients. Nephrology Dialysis Transplantation, 25(2), 538-554. doi: 10.1093/ndt/gfp487

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