- 期刊
降低透析病人人工腎臟發生凝固之改善專案
The Project for Decreasing the Clotting Rate of Artificial Kidney
摘要
本單位為區域教學醫院血液透析室，歷年來意外事件中以人工腎臟凝固居首，2011年發生率由（千分之0.79）上升至2013年的（千分之1.99），且八成以上的凝固是發生在無肝素透析治療中，故本專案目的在降低人工腎臟凝固發生率。分析人工腎臟凝固發生率增加的原因為：護理人員缺乏人工腎臟凝固處理與護理相關訓練知識、單位缺少無肝素血液透析技術稽核機制、病人透析管路流速不良。針對上述問題擬定改善對策，包括：規劃血液透析學理和臨床技術指導課程、修訂無肝素血液透析技術作業標準、製作「無肝素血液透析技術」數位學習光碟、採購計時器。經由改善方案實施後2014年血液透析室人工腎臟凝固發生率下降至（千分之0.52），目標達成率92.5%，並節省醫療耗材成本10,545元。本專案發現運用有效的方法與政策的推動，不但可降低醫療成本的支出，也能提升透析品質及優質的護理服務。
並列摘要
Clotted artificial kidney during hemodialysis was the most common accident in our dialysis center of a regional teaching hospital. The incidence rate increased from 0.79% in 2011 to 1.99% in 2013. From these accidents, 80% occurred in the heparin-free dialysis setting. The goal of our project is to reduce the rate of blood clotting from artificial kidney during hemodialysis. The analysis showed the major prompt of artificial kidney clotted were the dysfunctional training of heparin-free hemodialysis, lack of monitoring mechanism of heparin-free hemodialysis and inadequate flow of vascular access. In order to solve the encountered problems, we developed several methods including development of the teaching program for clinical technique, modifying the standard procedure of heparin-free hemodialysis, completing home-learning video disc and purchasing several timers. After the implementation of this program, the clotting rate in 2014 lowered to 0.52%, the target achieving rate was 92.5% and $10,545NT of the medical expense was saved. In conclusion, through the effective strategies and improvement of policies, we can upgrade the hemodialysis quality, reduce the unexpected medical expense and provide high quality of nursing service.