中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (07): 494-496.doi: 10.3969/j.issn.1671-4091.2018.07.016

• 护理研究 • 上一篇    下一篇

PDCA 循环管理在维持性血液透析患者血磷管理中的应用

章海芬1, 陶幸娟2,王敏1   

  1. 1上海交通大学医学院附属仁济医院肾脏科
    2上海交通大学护理学院
  • 收稿日期:2018-01-22 修回日期:2018-05-11 出版日期:2018-07-12 发布日期:2018-07-12
  • 通讯作者: 陶幸娟 tao.xingjuan@shsmu.edu.cn E-mail:lzguan@sin.com
  • 基金资助:

    上海市卫计委项目2015MS-B15

Application of PDCA cycle in the management of hyperphosphatemia for patients on maintenance hemodialysis

  • Received:2018-01-22 Revised:2018-05-11 Online:2018-07-12 Published:2018-07-12

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摘要： 【摘要】目的探讨PDCA(P，Plan 计划；D，Do 实施；C，Check 检查；A，Action 处理)循环管理在维持性血透患者血磷管理中的应用效果。方法本研究采用自身前后对照的方法。选取血液透析患者136例，干预前患者均接受常规限磷教育，干预3 个月期间应用PDCA 循环管理法，内容包括血磷控制现状调查、高磷血症原因查找、血磷控制干预点确定、血磷管理目标设立、干预策略制定和落实、以及反馈与处理。研究采用参与式健康教育的方式，护患双方共同开发磷游戏扑克牌(练习牌)，并应用于限磷饮食技巧的强化。研究比较干预前后高磷血症患者比例，以及患者对血磷管理的满意度。结果136 例患者均完成本研究。经过3 个月的PDCA 循环管理，血磷≥1.78mmol/L 的患者比例从57%降至44%。高血磷患者比例较前有明显降低(χ2=4.250，P=0.039)；患者对血磷管理的满意度高于干预前(χ2=9.285，P=0.002)。结论PDCA 循环管理应用于维持性血透患者，能有效降低高磷血症患者比例，提升患者对血磷管理的满意度以及护理人员职业价值。

关键词: PDCA 管理, 血液透析, 高磷血症

Abstract: 【Abstract】Aim To explore the clinical implication of PDCA cycle (P, plan; D, do; C, check; A, action) in the management of hyperphosphatemia for maintenance hemodialysis patients. Methods This was a single group and self-control study. A total of 136 patients were enrolled. All participants received regular health education on phosphorus restriction, and were additionally provided with one-to-one education on dietary phosphorus restriction based on self-developed health education tool by designated nurses for three months. The whole quality improvement process was managed by PDCA cycle, including investigation, root cause finding, target identification, intervention development and implementation, feedback and action. Participatory health education was adopted to guide the development of health education tool and reinforce the control of dietary phosphorus intake. The percentage of patients with hyperphosphatemia and patient satisfaction were evaluated. Results All participants completed the study. The percentage of patients with a serum phosphorus level equal to or above 1.78mmol/L was decreased significantly, from 57% to 44% (χ2＝4.250, P=0.039). Patients satisfaction on phosphorus management was achieved after the implementation of PDCA cycle (χ2＝9.285, P=0.002). Conclusions The implementation of PDCA cycle can reduce the ratio of patients with hyperphosphatemia, improve patient satisfaction, and help nurses gain a sense of personal and professional achievements.

Key words: PDCA cycle, hemodialysis, hyperphosphatemia