ประสิทธิผลของการใช้แนวปฏิบัติการดูแลสำหรับผู้ที่ได้รับ การผ่าตัดเชื่อมต่อหลอดเลือดชนิดถาวรสำหรับการฟอกเลือด ด้วยเครื่องไตเทียม โรงพยาบาลมหาราชนครเชียงใหม่

Abstract

The management of patients with end stage renal disease is supportive through renal replacement therapy with hemodialysis. Hemodialysis is done through a surgically created arteriovenous fistula which is prone to complications such as thrombosis, infection, and aneurysm. Care for a permanent hemodialysis vascular access is very important for healthcare providers and patients. This operational study aimed to determine the effectiveness of implementing care guidelines for persons with permanent hemodialysis vascular access. This guideline was developed by the multidisciplinary care team of a university hospital. The participants of the study consisted of 25 patients undergoing permanent hemodialysis vascular access, 13 before and 12 after the guideline implementation. The guideline was implemented by 13 nurses who care for those patients. The process of CPGs implementation was based on the evidence implementation framework proposed by the National Health & Medical Research Council (1999). A care behavior assessment questionnaire, developed by the researcher, was used to evaluate the outcome of CPGs implementation. Data were analyzed by using descriptive statistics. The result of study revealed that among participants who did not receive care according to the guideline, 10 participants had a moderate level of care behavior and the rest had a low level. For the participants who received care according to the guidelines, 8 participants had a good level while 4 had a moderate level of care behavior. The findings of this study confirm that the developed guidelines can be used to promote better care behavior among persons with permanent hemodialysis vascular access. Further study should be done to test the effectiveness of guideline implementation over a longer period of time in order to ascertain the sustainability of the outcome. Other outcomes of using these guidelines should be tested too.