長照機構執行安寧緩和照護介入之成效初探

Preliminary Study on the Effect of Hospice and Palliative Care in Long-term Care Institutions

洪一文(Yi-wen Hung) ； 陳純純(Chun-chun Chen) ； 王英偉(Ying-wei Wang) ； 謝至鎠(Jyh-gang Hsieh) ； 江淑莞(Shu-wan Chiang) ； 張智容(Chih-jung Chang) ； 王淑貞(Shu-chen Wang) ； 吳淑貞(Shu-chen Wu)

《安寧療護雜誌》 21卷3期 (2016/11) Pp. 245-257

https://doi.org/10.6537/TJHPC.2016.21(3).1

摘要

研究目的：旨在初步探討長照機構執行安寧緩和照護介入之成效。材料與方法：採病歷回溯的描述性研究法，收集機構長者接受某安寧居家療護之病歷，以結構式量表收集資料，收案時間自2014 年1 月1 日至 2015 年7 月31 日。研究工具分別為樣本的(一)基本特性、(二)醫療紀錄表：包括簽署「維生醫療指示醫囑」(Physician Orders forLife-Sustaining Treatment；POLST)前後三個月內之急診就醫次數、住院天數、用藥種類數及用藥量等。(三)維生醫療指示醫囑(POLST)。研究結果：個案平均年齡81 歲，在簽署POLST 後，其急診就醫次數、住院次數及天數等皆明顯減少，但門診次數及藥物用量則無明顯差異，預立維生醫療指示醫囑(POLST)執行之成效為100％。討論與臨床應用：研究顯示在機構簽署POLST 及執行安寧緩和照護成效良好。機構工作人員若能在適當時機照會安寧共同照護團隊，及早與機構住民及家屬討論臨終醫療決策，早期簽署POLST 能降低機構住民在生命末期無效或過度醫療使用的情形。

關鍵字

機構住民 ； 安寧緩和照護 ； 預立醫療指示 ； 維生醫療指示醫囑 ； 機構善終

並列摘要

Purpose: This study conducted a preliminary investigation on the effect of hospice and palliative care in long-term care institutions. Research method: This study adopted a retrospective descriptive research. Medical records of older adults who received hospice care in a residential institution were recruited. Data were collected using structured scales. The data collection was from January 1 , 2014 to July 31, 2015. Research instruments: This study employed three instruments to collect data: (1) demographic data of the patients; (2) medical history forms, including data such as the number of emergency visits, days of hospitalization, and the types and quantity of medicine prescribed 3 months before and after a patient signed a Physician Orders for Life-Sustaining Treatment (POLST); and (3) POLST document. Research results: The investigated patients were aged an average of 81 years. Their POLST execution rate reached 100%. A comparison shows that after signing POLST, the number of emergency visits as well as the number and length of hospitalizations significantly decreased, whereas the number of outpatient visits and the quantity of prescribed medicine did not change significantly. Discussion and clinical applications: The results demonstrated the feasibility of signing POLST and executing hospice and palliative care in institutions. If the staff of an institution can advise the hospice care team at an appropriate time to discuss end-of-life medical decisions with institution residents and their family members, then the signing of POLST facilitates a reduction in ineffective or excessive medical treatments administered to institution residents at the ends of their lives. This enables residents to receive comfortable and dignified end-of-life care.

並列關鍵字

institution residents ； hospice and palliative care ； advance directive ； Physician Orders for Life-Sustaining Treatment ,good death in institutions

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