降低腹膜透析病人腹膜炎發生率改善專案

Abstract

背景：腹膜炎是造成腹膜透析患者退出治療（drop-out）的最大原因。本腹膜透析中心位在北台灣的醫學中心，腹膜炎發生率由2014年1.51次/百病人月上升至2015年2.37次/百病人月。 目的：（1）了解腹膜炎之原因（2）實施有效再訓練計畫降低腹膜炎。 解決方案：發展新版腹膜炎認知及技術評核表、修訂再訓練流程、舉辦團體衛教、張貼衛教海報及發送衛教單張，並持續追蹤修正計畫。 結果：實施新版再訓練計畫後，感染事件由平均8次/月大幅降為4次/月，感染率更降至0.94次/百病人月。 結論：修訂再訓練流程，建立一致且持續性認知及技術全面性評核制度，確實能降低腹膜炎。  Background & Problems: The most significant cause for peritoneal dialysis (PD) patients to drop out is peritonitis. Our PD center is located in a medical center in Northern Taiwan. The peritonitis rate of our center increased from 1.51 episodes per 100 patient-months in 2014 to 2.37 episodes per 100 patient-months in 2015. Purposes: To (1) understand the causes of peritonitis among peritoneal dialysis patients, and (2) further implemented an effective retraining program to reduce peritonitis rate. Resolution: We developed a checklist including peritonitis prevention cognition and exchange technique. Retraining program was refined with continuous adjustment. Holding group education, setting up educational posters and delivering leaflets to convey information about peritonitis prevention were also applied. Results: After initiating the refined retraining program, infectious episodes decrease to 4 times/month form 8 times/month on average in the last 3 months. Peritonitis rate significantly went down to 0.94 episodes per 100 patient-months from 2.37 in 2015. Conclusion: The refined retraining program showed that a coherent procedure assessing system and a comprehensive cognition/ technique evaluation could lower the peritonitis rate.