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篇名 提升八大非癌末期住院病人之家屬不施行心肺復甦同意書簽署率
卷期 28:4=100
並列篇名 Enhance Do Not Resuscitate Consent Rate of Family Members in Eight Non-cancer Terminal Inpatients
作者 林品瑩許霈欣葉函霖吳怡樺林苡晴胡瑞桃陳家惠鍾蘭香
頁次 611-625
關鍵字 八大非癌不施行心肺復甦術同意書簽署率eight non-cancerdo not resuscitate consent rate
出刊日期 201712
DOI 10.3966/102673012017122804004

中文摘要

為減少病人臨終前施行心肺復甦術的痛苦、降低病人接受侵襲性照護及無效醫療等情況, 引發進行此專案的動機。本專案主要目的依據行政院衛生福利部評鑑安寧照護相關涵蓋率,提升 八大非癌末期住院病人之家屬不施行心肺復甦同意書簽署率達>60.0%。統計本院2016 年1-5 月 符合針對八大非癌末期住院病人之家屬DNR 同意書簽署(不含急診及加護單位),簽署率僅達 24.1%。組成本專案小組,現況分析家屬方面問題包括:不瞭解簽署可減輕末期病人痛苦、簽署 後可反悔終止、或撤除及簽署後擔心醫療人員不能盡心盡力照顧病人等。醫師方面:不瞭解及未 於HIS 系統開立末期診斷確認書。護理人員方面:不瞭解八大非癌相關診斷末期定義及簽署DNR 同意書最近親屬之順序與範圍。措施方案包括製作宣導海報、舉辦家庭會議、製作認識八大非癌 電子書(含末期評估及叮嚀)、定期監控各單位醫護人員執行情形等。透過方案積極介入,結果 顯示末期住院病人之家屬不施行心肺復甦同意書簽署率達77.8%,著實達到專案改善的目的。

英文摘要

The motivation of this project was to keep end-of-life patients free from pain resulting from attempting cardiopulmonary resuscitation (CPR), reducing the number of patients that choose to accept invasive and/or unnecessary care. The purpose of this project was to enhance the consent rate of do not resuscitate (DNR) among family members of eight non-cancer terminal inpatients to more than 60% as set by the Ministry of Health and Welfare accreditation. The results of the analysis conducted from January to May 2016 showed that the DNR consent rate of family members in eight non-cancer terminal inpatients was only 24.1%. Several problems were identified by the project team, including family members domain: lack of understanding that DNR can reduce the suffering of patients, lack of understanding that the DNR could be terminated or withdrawn, and concerns that the medical team would not provide adequate care if DNR is signed; physician domain: unfamiliarity with the terminal diagnosis confirmation and also fail to perform the confirmation in the healthcare information system (HIS); nursing staff domain: unfamiliarity with the definition of eight non-cancer terminal diseases diagnosis and lack of understanding of the hierarchical order of signing DNR consent among family members. The interventions of the project included making posters, conducting family meetings, creating the E-books, and regular monitoring the implementation of these procedures conducted by medical staff in the eight non-cancer terminal inpatient wards. Through the intervention, the DNR consent rate among family members increased to 77.8%, reaching the goal of the project.

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