提升八大非癌末期住院病人之家屬不施行心肺復甦同意書簽署率

Enhance Do Not Resuscitate Consent Rate of Family Members in Eight Non-cancer Terminal Inpatients

林品瑩(Pin-Ying Lin) ； 許霈欣(Pei-Shin Hsu) ； 葉函霖(Han-Lin Yeh) ； 吳怡樺(Yi-Hua Wu) ； 林苡晴(Yi-Ching Lin) ； 胡瑞桃(Shui-Tao Hu) ； 陳家惠(Chia-Hui Chen) ； 鍾蘭香(Lan-Hsiang Chung)

《長庚護理》 28卷4期 (2017/12) Pp. 611-625

https://doi.org/10.3966/102673012017122804004

摘要

為減少病人臨終前施行心肺復甦術的痛苦、降低病人接受侵襲性照護及無效醫療等情況，引發進行此專案的動機。本專案主要目的依據行政院衛生福利部評鑑安寧照護相關涵蓋率，提升八大非癌末期住院病人之家屬不施行心肺復甦同意書簽署率達＞60.0%。統計本院2016年1-5月符合針對八大非癌末期住院病人之家屬DNR同意書簽署（不含急診及加護單位），簽署率僅達24.1%。組成本專案小組，現況分析家屬方面問題包括：不瞭解簽署可減輕末期病人痛苦、簽署後可反悔終止、或撤除及簽署後擔心醫療人員不能盡心盡力照顧病人等。醫師方面：不瞭解及未於HIS系統開立末期診斷確認書。護理人員方面：不瞭解八大非癌相關診斷末期定義及簽署DNR同意書最近親屬之順序與範圍。措施方案包括製作宣導海報、舉辦家庭會議、製作認識八大非癌電子書（含末期評估及叮嚀）、定期監控各單位醫護人員執行情形等。透過方案積極介入，結果顯示末期住院病人之家屬不施行心肺復甦同意書簽署率達77.8%，著實達到專案改善的目的。

關鍵字

八大非癌 ； 不施行心肺復甦術同意書簽署率

並列摘要

The motivation of this project was to keep end-of-life patients free from pain resulting from attempting cardiopulmonary resuscitation (CPR), reducing the number of patients that choose to accept invasive and/or unnecessary care. The purpose of this project was to enhance the consent rate of do not resuscitate (DNR) among family members of eight non-cancer terminal inpatients to more than 60% as set by the Ministry of Health and Welfare accreditation. The results of the analysis conducted from January to May 2016 showed that the DNR consent rate of family members in eight non-cancer terminal inpatients was only 24.1%. Several problems were identified by the project team, including family members domain: lack of understanding that DNR can reduce the suffering of patients, lack of understanding that the DNR could be terminated or withdrawn, and concerns that the medical team would not provide adequate care if DNR is signed; physician domain: unfamiliarity with the terminal diagnosis confirmation and also fail to perform the confirmation in the healthcare information system (HIS); nursing staff domain: unfamiliarity with the definition of eight non-cancer terminal diseases diagnosis and lack of understanding of the hierarchical order of signing DNR consent among family members. The interventions of the project included making posters, conducting family meetings, creating the E-books, and regular monitoring the implementation of these procedures conducted by medical staff in the eight non-cancer terminal inpatient wards. Through the intervention, the DNR consent rate among family members increased to 77.8%, reaching the goal of the project.

並列關鍵字

eight non-cancer ； do not resuscitate consent rate

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