運用多元教學方案改善腹膜透析病人鈣磷乘積專案

背景：透析病人鈣磷乘積增加會導致副甲狀腺機能亢進、血管鈣化並提高死亡率。統計2018年1至6月腹膜透析病人鈣磷乘積小於60 mg²/dL²的比率平均為73.2%，未達閾值且低於健保監測標準故引發動機。 目的：本專案旨在降低腹膜透析病人鈣磷乘積以達標準75%。 解決方案：分析確立問題為病人對疾病認知不足、飲食攝取知識不足、藥物服用遵從性不佳、輔助工具不足。運用介入措施包括提供血磷檢驗趨勢圖、小組團體衛教、高磷影音教學、手機查詢APP及成立專案衛教Line群組等方案。 結果：專案推動後，病人鈣磷乘積小於60 mg²/dL²的比率，由2018年6月72.8%至2019年1月提高到82.2 %，已達閾值及健保監測標準。 結論：此專案運用團體衛教、影音教學及行動裝置，加強病人自我照顧能力，確實能有效提升護理指導成效，改善照護品質。  Background:The increased calcium -phosphorus product in dialysis patients will lead to hyperparathyroidism,vascular calcification and increase mortality. Statistics from January to June 2018, the ratio of calcium - phosphorus products less than 60 mg²/dL² averaged 73.2% of patients with peritoneal dialysis, which did not reach the threshold and was lower than the health care monitoring standard, so the engine was cited. Purpose:This project aims to reduce the calcium - phosphorus product of peritoneal dialysis patients to reach the standard 75%. Resolution:We analyzed and established that the problems were inadequate patient awareness of the disease, insufficient knowledge of dietary intake, poor compliance with medication, and insufficient aids. The intervention measures include providing trend chart of blood phosphorus test, group health education, high phosphorus audio-visual teaching, mobile phone query APP and establishment of Line group. Results:After the promotion of the project, the ratio of calcium-phosphorus product less than 60 mg²/dL² increased from 72.8% in June 2018 to 82.2% in January 2019, which has reached the threshold and health care monitoring standards. Conclusion:This project uses group health education, audio-visual teaching and mobile devices to strengthen patient’s self-care ability, which can effectively improve of nursing guidance to improve the quality of care.