跨團隊合作提升癌末緩和醫療家庭諮詢率

Increasing the palliative family conference rate for terminal cancer patients by means of an interdisciplinary quality improvement project

周佩君(Pei-Chun Chou) ； 呂雅珊(Ya-Shan Lu) ； 陳宜珊(Yi-Shan Chen) ； 劉錦燕(Chin-Yen Liu) ； 翟麗紅(Li-Hong Zhai)

《醫務管理期刊》 20卷4期 (2019/12) Pp. 342-359

https://doi.org/10.6174/JHM.201912_20(4).342

摘要

目的：病人、家屬和醫療人員間良好的溝通是生命末期安寧照護中重要的核心要素。個案醫院有將近七成個案死亡前從未接受緩和家庭諮詢，期望透過跨團隊合作的方式，瞭解癌末病患之緩和醫療家庭諮詢比率低的要因及提供改善策略。方法：透過品管圈的運作方式分析與確立癌末個案緩和醫療家庭諮詢比率低的要因，運用創意改善手法來擬定改善策略。結果：在醫護團隊的共同推動下，透過建立篩選機制、設計宣傳品、建立結構式表單與增加獎勵機制進行改善，癌末個案緩和醫療家庭諮詢率由改善前38%提升至76.2%，達到專案改善目的。結論：透過跨醫療團隊合作除了提升醫護人員的溝通能力，並建立篩選個案與會議驅動機制，施行的過程可作為其他醫療機構品質改善的參考。

關鍵字

跨團隊合作 ； 緩和醫療家庭諮詢會議 ； 生命末期照護 ； 品質提升

並列摘要

Objectives: A core element of end-of-life hospice care is good communication between patients, family members and health care professionals. In our hospital, nearly 70% of our end-of-life patients have never participated in palliative family conferences before death. It is hoped that the implementation of interdisciplinary cooperation will help raise the palliative family conference rate for terminal cancer patients. Methods: Through quality control circle (QCC) process, analysis was conducted to ascertain factors that contribute to low palliative family conferences rate for cancer patients at end-of-life. Subsequently, innovative improvements were made in order to strengthen the strategies applied in this area. Results: Owing to our medical teams' joint efforts to promote family conferences for terminal cancer patients, included setting up a screening process, designing products for education, formulating standard documents, and rewarding good performance of health care providers. The rate of palliative family conferences rate for cancer patients at end-of- life increased from 38% to 76.2% and reached the target set out for the improvement project. Conclusions: The teamwork that was achieved allowed us to improve the communication skills of medical staff and establish mechanisms for screening patients and support meetings. This implementation process can be used as a reference for the quality improvement projects undertaken by other medical institutions.

並列關鍵字

Interdisciplinary cooperation ； palliative family meeting ； end-of-life care ； quality improvement

參考文獻

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