提升重症末期病人善終準備達成率

Enhance the Reserve Ratio for Hospice Preparations with a Terminally-illed Patient

10.6530/YYN/2016.3.4

李怡濃(Yi-Nung Lee)；許瀚仁(Han-Jen Hsu)；康豑云(Chih-Yun Kang)

善終準備 ； 末期 ； 重症病人 ； Hospice preparation ； terminally ； critical patients

源遠護理

10卷2期（2016 / 06 / 01）

48 - 53

繁體中文

本專案目的為提升重症末期病人善終準備達成率，並提升末期病人死亡品質。臨床發現，「善終準備」不僅可以提升臨終照護品質，也能安撫家屬哀傷情緒，但在重症單位，幾乎未實施「善終準備」，在2011年安寧緩和醫療條例第二次修訂後，將八大非癌症患者納入安寧健保給付，允許末期病人撤除維生醫療，讓末期病人與家屬也能準備善終，故引發本專案探討動機。經調查分析其原因為醫療團隊與家屬之間對於臨終無共識、醫療人員缺乏臨終照護相關教育訓練、相關臨終政策宣導不足、臨終資源末整合。本專案解決方案是制定重症末期病人照護標準流程、規劃臨終在職教育、建構臨終溝通平台、及整合臨終資源。專案執行後單位重症末期病人善終準備達成率提升到68%，進而讓重症末期病人與家屬達到「生死兩相安」的境界，讓更多重症醫療人員除了有能力救治病人疾病，也能維護病人的死亡尊嚴，讓「善終」成為病人最美的祝福。

This project was to improve the hospice-readiness rates and the quality of care for terminally ill patients, to enhance both the quality of dying, and to appease family members' sad feelings. However, the ＂hospice ready＂ was seldom implemented in intensive units. The law was revised in 2011 in Taiwan regarding hospice and palliative care that qualify for health insurance payment was extended to include eight non-cancer diagnosed terminally ill patients. Terminally ill patients now have the right to withdraw life support system to allow both patients and their families prepare for death. An initial investigation discovered that there were gaps on understanding between the medical team and the patients and families. The medical and healthcare staff lack education and training, and are inadequate advocates to promote the updated law and properly use resources. This project developed a standard of care and flow process for the care of terminally ill, set an end of life care education curriculum, established a communication channel and integrated a utilization plan for resources. The rates of hospice ready for terminally ill patients increased to 68 percent so that both patients and their families experience ＂peaceful death.＂ It enhanced intensive medical staff's ability to treat patients with respect and dignity during the dying process so that ＂hospice＂ became a blessing for the dying patients.

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