20 mg/dl 18-39Patterson et al., mg/dl mg/dl mg/dl

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1 19 * ** Amann, Gross, London, & Ritz, 1999 Uhlig et al., 2010; Patterson et al., 2010 Kidney Disease Outcome Quality Initiative, K/DOQI 5.5 mg/dl 5.5 mg/dl * ** (02) suhchin@msbh.ntuh.gov.tw DOI /

2 20 mg/dl 18-39Patterson et al., mg/dl mg/dl mg/dl

3 21 n = CaCO 3 CaphosUlcerin RenagelFosrenol VitD3AlfarolCacijex Zamplar

4 高磷食物種類多無法說出一日所需食物護理指導不完整每次照顧工作忙碌不同病人休假時未遇無法連續指導到主護病人未確實追蹤病人按時服藥 忘記帶藥出門藥品服用遵從性不佳味道不好 覺得吃了沒效 護理師 不想吃藥 未按時吃藥 怕有副作用 病人 設備 鈣磷與副甲狀腺素變化使用的相關藥物認知不足 太忙忘記吃藥 無高血磷合併症相關海報護理指導不一致來自不同醫療院所經驗不同 無法正確說出血磷值 無高血磷標準照護規範 無法正確說出含磷高食物 無法正確說出高血磷合併症 輔助工具設計不佳 純文字護理指導單張無吸引力 食物攝取認知不足 無法正確說出如何控制含磷食物的攝取量疾病認知不足 血液透析病人血磷監測值達成率低 64.1%

5 ~90 glomerular filtration rate, GFR 25 Patterson et al., K/DOQI mg/dl 5.5 mg/dl Uhlig et al., mg/dl 2008 Patterson et al., , K/DOQI 30~35 Kcal/kg IBW/day 1.2~1.3 g/ kg IBW/day 800~1, Patterson et al., Nerbass2010

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9 百分比 2011 年改善前百分比 2012 年改善後百分比 閾值設定為 70% 1 月 2 月 3 月 4 月 5 月 6 月 百分比 0 改善前百分比改善後百分比 能按時服藥 正確說出控制含磷飲食的攝 正確說出高血磷的合併症 正確說出本月抽血報告的血 正確說出三種含磷高的食物

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11 Amann, K., Gross, M. L., Lodon, G. M., & Ritz, E. (1999). Hyperphosphataemiaa silent killer of patients with renal failure. Nephrol Transplant, 14(9), Nerbass, F. B., Morais, J. G., afaela dos Santos, R. G. D., Krüger, T. S.,. Koene, T. T., Filho, H. A. D. L. (2010). Adherence and knowledge about hyperphosphatemia treatment in hemodialysis patients with hyperphosphatemia. Jornal Brasileiro de Nefrologia, 32(2), Patterson, L. A., DeBlieux, P. M. (2010). Hyperphosphatemia in emergency medicine clinical presentation. Retrieved from medscape.com/article/ clinical Sun, C. Y., Chang, K. C., Chen, S. H., Chang, C. T., Wu, M. S. (2008). Patient education: An efficient adjuvant therapy for hyperphosphatemia in hemodialysis patients. Renal Failure, 30(1), Uhlig, K., Berns, S. J., Kestenbaum, B., Kumar, R., Leonard, M. B., Martin, K. J., Sprague, S. M., Goldfarb, S. (2010). KDOQI US Commentary on the 2009 KDIGO clinical practice guideline for the diagnosis, evaluation, and treatment of CKD-mineral and bone disorder (CKD-MBD). American Journal of Kidney Diseases, 55(5),

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14 32 Projects of Achievement of Serum Phosphate Goal among Hemodialysis Patients Chin-Ling Chiang Ching-Ling Liang Chien-Ju Lin Hsueh-Fang Chuang * Suh-Chin Wang ** Abstract Hyperphosphatemia increases morbidity and mortality rates among patients undergoing maintenance hemodialysis. From January to June in 2011, only 64.1% of patients in our unit reached the target of the phosphate standard which was less than the care threshold. Analysis found that this was probably due to the following reasons: poor drug compliance, insufficient knowledge of food intake, as well as a lack of assistance and facilitating tools from our nursing team. The main purpose of our project was to raise the serum phosphate standard target achievement rate among hemodialysis patients. Through group discussion, we developed several strategies that were carried out from September 20, 2011 through to June 30, These included setting standards on hyperphosphatemia care, using pictures as care instruction tools, and passports for individual diet and medication. The achievement rate subsequently increased from 64.1% to 71.9%, and drug compliance improved from 34% to 91%. If nurses use the complete instruction tools and patients use the passports to selfmonitor their food and drugs, we can effectively raise the achievement rate for the serum phosphate target among hemodialysis patients. Key words: hemodialysis, hyperphosphatemia, achievement of serum phosphate goal RN, Hemodialysis Room, National Taiwan University Hospital, Bei-Hu Branch Head Nurse, Hemodialysis Room, National Taiwan University Hospital, Bei-Hu Branch * Director of Nursing, National Taiwan University Hospital, Bei-Hu Branch ** Received: Dec. 13, 2013 Revised: Feb. 10, 2014 Accepted for publication: May. 21, 2014 Correspondence: Suh-Chin Wang No. 87, Neljiang St., Wanhua Dist., Taipei City 108, Taiwan (ROC) Telephone: (02) ext suhchin@msbh.ntuh.gov.tw DOI: /