- 期刊
運用醫病共享決策降低加護病房重症末期病人無效醫療比率
Apply Medical and Patient-sharing Decisions to Reduce the Medical Futility Treatment Rate of Ill Terminal Patients in the Intensive Care Unit
摘要
加護病房病人病情進展快速，家屬缺乏足夠訊息及思考治療方向，難以達具共識的抉擇，院方配合醫策會推動發展病人決策輔助工具，發現使用效果不盡理想，經調查發現主要問題有醫療團隊病情解釋無法讓家屬聽懂、人員缺乏相關教育訓練、臨終政策宣導不足且輔助決策工具圖片字太小、文字過多等，引發筆者進行改善的動機。透過專案建制單位末期臨終抉擇流程、『生命末期病人臨終照護選擇』PDA手冊並建立SDM資訊平台，整合臨終資源，減少末期病人無效醫療並提升病人死亡品質。專案實施後，家屬壓力指數降低至4.5分且醫療決策輔助使用率提升30%，降低無效醫療產生，達此專案目的，醫療人員瞭解除醫治病人疾病，亦能維護病人死亡的尊嚴，整體提升醫療照護品質。
並列摘要
In the intensive care unit, the patient's condition progress rapidly, the family members lack sufficient information and were not capable of decision-making in terms of treatment direction, hence made it hard to reach a consensus decision. The hospital cooperates with the Medical Policy Association to promote the development of decision-making aids for patients, and discovered that the results were not satisfactory. After investigation, it was found that the main problems were that the medical team's explanation could not be understood by the family members; the inadequacy education and training of nursing personnel; the end-of-life policy promotion was insufficient; and the pictures and slogans of the auxiliary decision-making tools were too small as well as too much wording and so on. That inspired the author's motivation for improvement. Through the end-of-life selection process of the project-organized unit, PDA manual of ＂The Choice of End-of-Life Patient's Terminal Care＂ and the establishment of an SDM information platform to integrate end-of-life resources, reduce end-of-life patients' ineffective medical treatment and improve the quality of patient's death. After implementation of this project, the anxiety score of family members reduced to 4.5 points and the utilization rate of medical decision-making assistance increased by 30%, which also reduced the occurrence of ineffective medical treatment. The intention of this project was fulfilled, the medical staffs understand apart from curing disease, they can also maintain patients' dignity towards deaths, and therefore improve the quality of medical care overall.