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

10.3966/102673012017122804004

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)

八大非癌 ； 不施行心肺復甦術同意書簽署率 ； eight non-cancer ； do not resuscitate consent rate

長庚護理

28卷4期（2017 / 12 / 01）

611 - 625

繁體中文

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。

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understanding that DNR can reduce the suffering of patients, lack of understanding that the DNR could be terminated or withdrawn, and concerns that the medical team would not provide adequate care if DNR is signed; physician domain: unfamiliarity with the terminal diagnosis confirmation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.

1. 李慶源、楊朝富、楊梅伶(2013)。行動化生態觀察電子書之製作與應用。國立臺灣科技大學人文社會學報，9(3)，173-188。
   連結：
2. 許瀚仁、李怡濃、康豑云、陳蕙茹、葉春長、洪東源、高玉玲(2015)。外科重症生命末期整合護理照護模式。源遠護理，9(3)，20-26。
   連結：
3. 鄭秦妮、謝至鎠、王英偉、范聖育(2015)。不施行心肺復甦術與接受自然死亡：影響決策的標題與說明。安寧療護雜誌，20(1)，1-12。
   連結：
4. 羅耀明(2014)。探討中老年人於非正規教育機構參與善終課程後之DNR 觀點轉化。生命教育，6(1)，87-117。
   連結：
5. Cora, A.,Partinico, M.,Munafo, M.,Palomba, D.(2012).Helath risk factors in caregivers of terminal cancer patients.Cancer Nursing,35(1),38-47.
6. Wen, K. Y.,Lin, Y. C.,Cheng, J. F.,Chou, P.C.,Wei, C. H.,Chen, Y. F.,Sun, J. L.(2013).Insights into Chinese perspectives on do-notresuscitate (DNR) orders from an examination of DNR order form completeness for cancer patients.Support Care Cancer,21,2593-2598.
7. 吳讚美、林惠賢、賈佩芳、蔡玉梅、施丞貴、謝志松(2012)。護理人員執行不施予心肺復甦術之現況及相關因素之探。安寧療護雜誌，17(2)，146-161。
8. 姚建安(2014)。醫療機構施行安寧緩和醫療作業案例集。台北=Taipei:衛生福利部=Ministry of Health and Welfare。
9. 陳榮基(2015)。醫院應遵循〈安寧緩和醫療條例〉維護病人善終權益。醫院雙月刊，48(1)，7-12。
10. 陳願任、林益卿(2015)。台灣DNR 制度與預立醫囑。家庭醫學與基層醫療，30(11)，326-330。
11. 黃馨葆、陳皇吉、蔡佩渝、謝雅琪、林楷煌、蔡兆勳(2014)。如何以家庭會議協助重症病人生命末期決策。安寧療護雜誌，19(3)，267-281。
12. 楊鳳凰、李素貞、王瑞瑤、楊淑寬、林淑瑜、陳嘉惠(2015)。影響重症病人家屬簽署DNR 相關因素探討。澄清醫護管理雜誌，12(1)，30-39。
13. 衛生福利部(2013)‧安寧緩和醫療條例‧ 取自http://law.moj.gov.tw/Law/LawSearchResult.aspx?p=A&k1=%E5%AE%89%E5%AF%A7%E7%B7%A9%E5%92%8C%E9%86%AB%E7%99%82%E6%A2%9D%E4%BE%8B&t=E1F1A1&TPage。
14. 賴慶三(2015)。國小電子書的推展與實務。國民教育，55(4)，1-13。

1. 張淑美,張文演(2022)。某醫院生命末期病患接受家庭會議、安寧緩和照護與簽署不施行心肺復甦術之回溯性研究。安寧療護雜誌，26(3)，224-238。
2. 鍾宜真,劉雅絃,黃惠美,陳俊朋,陳孟君(2022)。某醫學中心住院病人簽署不施予心肺復甦術之概況探討。醫務管理期刊，23(4)，353-367。