Due to poor renal function of the patient with end stage renal disease, they depend on dialysis to remove excessive fluid and urea. The amount of removed fluid is based on the body weight. Hence, it’s the most important issue that how to correctly measure the body weight and ultrafiltration before and after dialysis. If there is an error in calculation and underestimating the body weight, it will lead to fluid overload and cause pulmonary edema or heart failure, which need to receive emergent hemodialysis. If overestimating body weight, it will lead to excess fluid removal during dialysis and result in severe complication such as hypotension, muscle spasm, vascular occlusion and shock.
The aim of this project is reduce the body weight difference rate of hemodialysis patients. It's not onlymaintain the security of the patient but also promote the nursing care quality.
Methods:
There are several ways to play the record of weighing measurement such as formulating the criterion of body weight measurement, setting the process of nursing practice, conducting in-service education and group health education, marking weighing scale by fluorescent stickers, designing the poster of measurement steps, making various version of measurement steps for countries, and using far infrared sensor.
Results:
The difference of body weight between predicted and actual post-dialysis is plus and minus 0.5 kilograms, which was set as an indicator by dialysis center. The average error rate of post-dialysis weight was 0.95% from July to December on 2016. There were three cases transferred to intensive care unit due to pulmonary edema, caused by insufficient ultrafiltration. According to analysis, the reason lead to the error as follow: 1.Incorrect process of measurement and manipulation 2.Paramedics record or measure the body weight in error. 3.The patient report the wrong body weight. 4.NPO during dialysis and without setting ultrafiltration appropriately. 5.Inconsistent subtraction between patient and paramedics about the weight of clothes. After performed the project and the body weight difference rate was improved from 0.95% to 0.27%.
Conclusion:
It’s not only affecting the safety of the patient but also requiring additional medication and medical cost, which were extra burden on patient and hemodialysis unit.It not only maintain the security of the patient but also promote the nursing care quality.