提升呼吸器依賴病人不施行心肺復甦術簽署率

Increasing Rate of Do Not Resuscitate Designation of Ventilator- Dependent Patients

朱璧岑(Pi-Chen Chu) ； 李榮真(Jung-Chen Lee) ； 黃如鶯(Ju-yin Huang) ； 吳大緯(Da-Wei Wu) ； 吳淑蓉(Shu-Jung Wu)

《高雄護理雜誌》 34卷3期 (2017/12) Pp. 24-35

https://doi.org/10.6692/KJN.201712_34(3).0003

摘要

配合衛生福利部呼吸器依賴病人安寧緩和醫療宣導政策，預提升不施行心肺復甦術簽署率，使病人盡早獲得安寧諮詢服務，期在疾病進展至末期時能免除痛苦無效醫療，獲得善終。於2014年9月成立專案小組，經現況分析確立問題，擬定改善方案並進行成效評估。經介入常規召開家庭會議並提供緩和醫療家庭諮詢服務、啟用醫令系統安寧提示功能、增加安寧緩和醫療宣導海報及衛教單，落實呼吸器依賴病人安寧共照標準作業並每月監測檢討，呼吸器依賴病人不施行心肺甦術簽署率由35.1%提升至74.1%。結果顯示運用品管改善手法，配合護理衛教工具、醫囑資訊提醒及結合跨團隊成員的參與推動、建立安寧共同照護標準化流程，可提升不施行心肺復甦術簽署率。

關鍵字

呼吸器依賴病人 ； 不施行心肺復甦術 ； 安寧緩和醫療

並列摘要

With the hospice-palliative care policy proposed by the Ministry of Health and Welfare, this project aimed to increase the rate of do not resuscitate (DNR) designation of ventilator-dependent patients. Patients could then receive the hospice-palliative care as early as possible and avoid futile medical treatments at the end of terminal care. In September 2014, a team was established to identify the problems, develop the improvement plans and evaluate the effectiveness of the project. Through conducting regular family meetings and palliative care counseling, implementing hospice alert in the physician order entry system, increasing use of education posters and leaflets of hospice-palliative care, applying and reviewing monthly care standards for hospice-shared care of ventilator-dependent patients, the rate of DNR designation of ventilator-dependent patients has been increased from 35.1% to 74.1%. The results of this project indicated that the rate of DNR designation could be increased by using health education tools, integrating alerts into the physician order entry system, initiating cross-team collaboration and establishing care standards for hospice-shared care.

並列關鍵字

ventilator-dependent patients ； DNR designation ； hospice-palliative care

參考文獻

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