以早期辨識末期病人提升重症病人Do Not Resuscitate討論率成果初探

Exploring the Effect of Increasing the Rate of Do Not Resuscitate(DNR) Discussion by Early Identification of End Stage Disease

10.6537/TJHPC.202012_25(1).01

馬瑞菊(Jui-Chu Ma)；林佩璇(Pei-Xuan Lin)；邱怡蓉(Yi-Jung Chiu)；于豎惠(Shu-Hui Yu)；蘇乃絹(Nai-Chuan Su)；李佳欣(Chin-Hsin Li)；鄭婉如(Wan-Ju Cheng)；蕭嘉瑩(Chia-Ying Hsiao)；蘇珉一(Min-I Su)

加護病房 ； 末期病人辨識 ； 早期不施行心肺復甦術討論 ； 緩和醫療 ； Intensive care unit ； End stage disease identification ； Early DNR discussion ； Palliative care

安寧療護雜誌

25卷1期（2020 / 12 / 01）

1 - 16

繁體中文

研究目的：研究指出重症病人接受早期介入DNR討論可以減少侵入性導管置放及無效醫療資源耗用，故本研究透過重症病人入加護病房時立即辨識病人是否符合末期繼而介入措施，旨在提升加護病房末期病人早期DNR討論之比率。材料與方法：採電子病歷回溯性調查設計，個案之末期定義係以Salpeter（2012）之研究；小於或等於6個月存活期之病人定義為末期病人（共539位），其中介入措施前（係指2016年5月1日至2017年4月30日）有226位符合末期定義，介入措施後（係指2017年5月1日至2018年4月30日）有313人符合末期定義。結果：末期病人早期辨識繼而介入措施後使得24小時內DNR討論比率由27.0％上升至37.4％（P = 0.011）達顯著差異。本研究顯示制定評估工具辨識末期病人、舉辦教育訓練、製作DNR討論輔助工具、製作生命末期溝通引導工具等措施能有效提升24小時內DNR討論比率。結論：早期辨識末期病人並及早介入DNR討論可提升重症醫療團隊提供緩和醫療之比例。

Purpose: Studies have shown that early DNR discussion for patients with end stage disease can reduce the need to consider the invasive catheter placement and prevent invalid consumption of medical resources. This study aimed to have an end stage disease identification when the patients entered the Intensive Care Unit and checked if they were with end stage disease and the intervention should then be applied. Thus, the rate of early DNR discussion for patients with end stage disease can be increased. Materials and Method: Electronic medical records were used to design a retrospective study, and the study by Salpeter (2012) was used for the end stage disease definition. The patients who survive for less than 6 months or only 6 months are defined as patients with end stage disease (totally 539 patients). Before the intervention (from May 1, 2016 to April 30, 2017), 226 patients were qualified to the end stage disease definition. After the intervention (from May, 2017 to April 30, 2018), 313 patients were qualified to the end stage disease definition. Result: Because of early end stage disease identification and intervention, the rate of DNR discussion in the Intensive Care Unit within 24 hours has increased with obvious difference from 27.0% to 37.4% (P = 0.011). This study showed that useful ways, which included making the assessment tool for checking end stage disease identification, organizing educational training programs, making the tool for supporting DNR discussion and making the tool for guiding the end-of-life communication, can effectively increase the rate of DNR discussion within 24 hours. Conclusion: Early end stage disease identification and early DNR discussion with intervention can increase the rate of palliative care provided by the critical care medical team.

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