加護病房護理人員撤除維生醫療改善方案

Project of Improving Withdrawal of Life-Sustaining Treatments in ICU

10.6537/TJHPC.2017.22(1).5

李佳欣(Chia-Hsin Li)；林佩璇(Pei-Xuan Lin)；羅元均(Yuan-Chun Lo)；邱怡蓉(Yi-Jung Chiu)；鄭婉如(Wan-Ju Cheng)；蘇珉一(Min-I Su)；林芸兌(Yun-Tui Lin)；馬瑞菊(Jui-Chu Ma)

加護病房 ； 撤除維生醫療 ； 安寧療護 ； Intensive Care Unit ； Withdrawal of Life Sustaining Treatment ； palliative care

安寧療護雜誌

22卷1期（2017 / 03 / 01）

54 - 74

繁體中文

安寧緩和醫療條例已通過將末期病人已給予之維生醫療，在尊重病人的生命及醫療自主權之下，經由二位醫師確診為末期病人，其用以維持生命徵象已無治癒效果，而只能延長瀕死過程的醫療措施，權衡得失弊大於利，加重病人受苦，在尊重病人的福祉及醫療自主權之下，得以撤除之。但實務執行面上卻常因護理人員對安寧條例、倫理法規等觀念偏差，加上撤除手續繁複無所依歸致使撤除維生醫療正確率低。故本專案旨在改善加護病房護理人員撤除維生醫療之正確率。經現況調查發現主要問題：未制定撤除維生醫療標準作業程序、撤除維生醫療照護標準手冊不完善、缺乏撤除維生醫療輔助工具、資訊系統路徑繁瑣及缺乏安寧療護相關教育訓練等。經專案設計（一）撤除維生醫療標準作業程序：制定撤除維生醫療作業規範及監測作業（二）撤除維生醫療照護標準手冊；修訂撤除維生醫療流程圖（三）撤除維生醫療輔助工具：1.製作撤除維生醫療提醒海報及教學光碟；2.每台e化工作車增設撤除維生醫療流程小卡（四）建置資訊系統簡便關鍵字查詢（五）加強安寧療護教育訓練：定期舉辦教育訓練等解決方案後，使撤除維生醫療正確率由41.53%提升至95.6%，除達成專案目的之外並對護理人員倫理思辨及臨終照護品質皆有助益。

Hospice Palliative Care Act grant terminal patients the conditional right to withdraw their life sustaining treatment with respect to their autonomy of life and medical treatment. Medical treatment may be withdraw when the following requirements are met. They are: The patient must be diagnosed as a terminal patient by two specialist doctors; currently adopted medical treatment is only used to maintain life signs and prolong the dying process; no treatment effect can be seen but prolong patient's suffering. However, as for the actual implementation, the completion rate of life sustaining treatment withdrawal is relatively low for the complex procedures and the nursing personnel's understanding of the Palliative Care Regulations and code of ethics. Therefore, this study aims to enhance the nursing personnel's completion rate of life sustaining treatment withdrawal in intensive care unit. After investigation, the main problems found include: no standard operating procedure for life sustaining treatment withdrawal has been formed; the standard manual for life sustaining treatment withdrawal has not been completed; lacking assisting tools used for withdrawal of life sustaining treatment; the information system path is complicated; and lacking relative education and training of palliative care. This project aims to fulfill the following objectives: design the Standard Operating Procedures for the Withdrawal of Life Sustaining Treatment (I): form the operation specifications of Life Sustaining Treatment Withdrawal and monitor the operation; complete the Standard Manual for Life Sustaining Treatment Withdrawal (II); modify the Flow Chart of Life Sustaining Treatment Withdrawal (III); make the assisting tools used to withdraw life sustaining treatment: 1. make warning posters and teaching discs for Life Sustaining Treatment Withdrawal; 2. put up the Flow Card of Life Sustaining Treatment Withdrawal on each e-nursing cart. (IV) on each sickbed; establish information system with the function of searching information via keywords (V); and enhance the education and training on palliative care. The education and training shall be regularly organized to raise the completion rate of Life Sustaining Treatment Withdrawal from 41.53% to 95.6%. Besides reaching the objectives of this project, the study is of great benefit in improving nursing personnel's reflection on ethics and enhancing quality of care for terminal patients.

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