Physician Orders for Life-Sustaining Treatment (POLST): Lessons learned from analysis of the Oregon POLST Registry
Physician Orders for Life-Sustaining Treatment (POLST): Lessons learned from analysis of the Oregon POLST Registry
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DOI：
10.1016/j.resuscitation.2013.11.027
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发表时间：
2014-04-01
期刊：
影响因子：
6.5
通讯作者：
Tolle, Susan W.
中科院分区：
文献类型：
--
作者：
Schmidt, Terri A.;Zive, Dana;Tolle, Susan W.
背景：医师生命维持治疗医嘱（POLST）已成为记录患者治疗偏好的常用手段。除了尝试复苏或不尝试复苏的命令，对于没有心肺骤停的患者，POLST提供三个级别的治疗：全面治疗，有限干预和仅舒适措施。俄勒冈州有一个在该州完成的POLST表格的电子登记处。我们使用注册数据来检查治疗顺序的不同组合。方法和结果：我们分析了2012年签署并进入俄勒冈州POLST登记处的表格的数据。分析包括31294份POLST表格。平均登记年龄为76.7岁。21,396家（68.4%）医院有“请勿尝试复苏”（DNR）命令，9900家（31.6%）医院有“尝试复苏”命令。6种顺序组合为：不复苏(DNR)/舒适措施仅10769例（34.4%）、DNR/有限干预9306例（29.7%）、DNR/全面治疗1211例（3.9%）、尝试心肺复苏(CPR)/舒适措施仅11例（0.04%）、尝试心肺复苏/有限干预2281例（7.3%）和尝试心肺复苏/全面治疗7473例（23.9%）。结论：最常见的顺序组合是仅采用DNR/舒适措施、DNR/有限干预和尝试复苏/全面治疗。这三点对健康专业人士来说是有意义的。然而，在危机时刻需要翻译的其他订单组合约为10%的注册人完成。这些组合需要进一步研究。2013爱思唯尔爱尔兰有限公司版权所有。
Background: Physician Orders for Life-Sustaining Treatment (POLST) has become a common means of documenting patient treatment preferences. In addition to orders either for Attempt Resuscitation or Do Not Attempt Resuscitation, for patients not in cardiopulmonary arrest, POLST provides three levels of treatment: Full Treatment, Limited Interventions, and Comfort Measures Only. Oregon has an electronic registry for POLST forms completed in the state. We used registry data to examine the different combinations of treatment orders.Methods and results: We analyzed data from forms signed and entered into the Oregon POLST Registry in 2012. The analysis included 31,294 POLST forms. The mean Registrant age was 76.7 years. 21,396 (68.4%) had Do Not Attempt Resuscitation (DNR) orders and 9900 (31.6%) had orders for "Attempt Resuscitation". The 6 order combinations were: Do Not Resuscitate (DNR)/Comfort Measures Only 10,769 (34.4%), DNR/Limited Interventions 9306 (29.7%), DNR/Full Treatment 1211 (3.9%), Attempt Cardiopulmonary Resuscitation (CPR)/Comfort Measures Only 11 (0.04%), Attempt CPR/Limited Interventions 2281 (7.3%), and Attempt CPR/Full Treatment 7473 (23.9%).Conclusions: The most common order combinations were DNR/Comfort Measures Only, DNR/Limited Interventions and Attempt Resuscitation/Full Treatment. These three makes sense to health professionals. However, other order combinations that require interpretation at the time of a crisis were completed for about 10% of Registrants. These combinations need further investigation. (C) 2013 Elsevier Ireland Ltd. All rights reserved.