建構完善的台北市居家安寧照護模式

Developing of a Comprehensive Home-Based Palliative Care Model in Taipei City

10.6200/TCMJ.201910/SP_16.0014

吳孟嬪(Meng-Ping Wu)；馮容莊(Rung-Chuang Feng)；黃美齡(Mei-Ling Huang)；何璇(Hsuan Ho)；孫文榮(Wen-Jung Sun)；黃勝堅(Sheng-Jean Huang)

安寧居家療護 ； 居家護理 ； 生命末期 ； 連續性照護 ； Home-Based Palliative Care ； Home Care, end-of-life ； Continuous care

北市醫學雜誌

16卷附冊（2019 / 10 / 31）

134 - 144

繁體中文

目的：本於了解安寧居家療護在北市施行的可行性，在不同院區安寧居家團隊與其簽屬不施行心肺復甦術（Do not Resuscitate, DNR）、收案狀況及安寧居家品質指標監測之分析，期期透過都會型安寧居家介入模式為基礎，以作為安寧居家職場之策略參考。方法：收集本院7個院區執行安寧居家現況，內容主要包括個案簽署DNR情況、收案狀況、各職類訪視狀況、安寧療護品質指標監測及主要照顧者滿意度調查，並使用描述性統計分析工具進行分析。結果：安寧居家服務服務人次逐年增加，居家護理自2016年簽屬DNR比率由原38.9%至2018年增加至60.38%，醫護訪視比率為0.57:1居全國之冠，及早介入安寧居家，安寧療護品質指標非計畫性再入院率逐年降低；善終準備紀錄單完整率皆維持100%，在宅往生率高達70.20%，滿意度平均高達99.90%，持續推動安寧品質監測指標包含非計畫再入院率、善終準備紀錄單完整率、健保給付之轉介數（社工師、心理師）、非健保給付轉介率及在宅往生率等監測指標。結論：透過團隊共識提供連續性的照護，緩解個案臨終前不適症狀，在五全照護下減輕個案及家屬身心負荷，讓個案在家屬及團隊的陪伴下完成在宅往生心願，才能夠發展有效的健康促進介入措施。

Purpose: This project examined the feasibility of home-based palliative care in Taipei City within branches of the Taipei City Hospital. Various variables including branch, signing of the Do not Resuscitate (DNR) order, sampling condition, and quality index of home-based palliative care were analyzed. The findings may be referenced and implicated in strategy and policy of palliative care. Methods: The current project overviewed the palliative care in 7 hospital branches including DNR order status, sampling, home visits by different types of medical personnel, quality of home-based palliative care, and satisfaction of caregivers. Results: The results showed that the service team provided service wherever people needed. The populations receiving home-based palliative care are increasing. The signed rate of DNR order during home-based nursing care increased from 34.93% in 2016 to 65.76% in 2018; the ratio of physician to nurse visits was 0.57:1, ranking at top in the nation. The rate of unplanned hospital readmission decreased gradually. The completion rate of hospice care preparation record, home mortality rate, and average satisfaction rate were 100%, 70.20%, and 99.90%, respectively. Other continuous promotion of palliative care quality indexes reported included readmission rate, completion rate of hospice care preparation records, number of National Health Insurance (NHI) coverage referrals (social workers and psychologists), and home mortality rate in non-NHI coverage referrals. Conclusion: The continuous care with team consensus relieves the discomfort before the end-of-life. With the relieve of physical and mental stress of the patients and their family under the 5 Ws care (whole person, whole family, whole course, whole team, and whole community) and last days spending at home accompanied with family and the medical team, a health-promoting intervention approach can only then be developed and implemented effectively.