安寧病患之困難出院分析：個案報告

Difficult Discharge of Patients in Hospice Care

10.3966/168232812018062802006

蔡翊昕(Yi-Shin Tsai)；林惠文(Hui-Wen Lin)；許碧珊(Pi-Shan Hsu)；蔡東啟(Dong-Chii Tsai)

困難出院 ； 出院計畫 ； 居家安寧服務 ； difficult discharge ； discharge planning ； hospice home care

台灣家庭醫學雜誌

28卷2期（2018 / 06 / 01）

101 - 107

繁體中文

困難出院，一直是醫療團隊於住院病患即將辦理出院準備服務之際，常面臨的潛在問題。安寧病患常因自身處於癌症末期或合併其他嚴重的共病，而比一般住院病患更容易因急性症狀反覆發作而出入安寧病房，並且在治療方面因需考量許多不同面相而更加複雜，也因此常發生病患或家屬拒絕出院，要求繼續住院治療的情形。一位64歲的女性護理之家住民為乳癌末期合併腦部及其他多重器官轉移，此次因癲癇頻繁發作，於一個月內再度入院接受治療，病患於近幾年常因許多急性問題如：肺炎、泌尿道感染、呼吸急促合併血氧下降等問題住院。當病患於住院後期病情穩定時，家屬多次拒絕醫療團隊提出的出院計畫。本文參考近年來針對安寧病患困難出院的研究文獻，並分析整理可能的原因及相對應的解決方法，以提供國內安寧療護人員之參考。

Difficult discharge has remained a potential problem for healthcare professionals when hospitalized patients are about to undergo discharge planning. Patients in hospice care are admitted more often than general inpatients due to the recurrence of acute symptoms, and the treatment for hospice residents can be highly complicated as a terminal illness or end-stage cancer is often associated with other serious comorbidities and an array of medical and other issues need to be taken into consideration. Resistance to discharge and request for prolonged hospitalization is therefore a common occurrence among hospice patients or their families. The report presents a case of a 64-year-old female nursing home resident admitted for breast cancer with brain and multiorgan metastasis. Due to frequent episodes of seizure, she was readmitted to the hospice within a month. In the past few years, the patient had suffered from many acute problems such as pneumonia, urinary tract infections, and shortness of breath combined with desaturation. When she was relatively stable in her later hospitalization, her family repeatedly rejected to discharge her. In this case report, possible causes of and corresponding solutions to difficult discharge for hospice patients are discussed by literature review. The goal of this case report is to provide references and experience for hospice care professionals in coping with cases of difficult discharge.

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