Improving end-of-life care in nursing homes: Implementation and evaluation of an intervention to sustain quality of care
Improving end-of-life care in nursing homes: Implementation and evaluation of an intervention to sustain quality of care
复制标题
DOI：
10.1177/0269216313480549
复制
发表时间：
2013-09-01
影响因子：
4.4
通讯作者：
Murray, Scott A.
中科院分区：
文献类型：
--
作者：
Finucane, Anne M.;Stevenson, Barbara;Murray, Scott A.
背景：在国际上，政策要求养老院提供可靠的良好的临终关怀。我们进行了一个为期20个月的项目，以维持姑息治疗的改善所取得的先前intervention.Aim：为了维持高标准的姑息治疗在七个英国护理院使用较低水平的支持比雇用在原来的项目，并评估这种干预的有效性。设计：两名姑息治疗护士专家每周各花一天时间为联合王国苏格兰的七家护理院提供支助和培训;结果：在可持续发展项目期间，有132名居民死亡。与初始干预相比，（a）具有预期护理计划的已故居民比例（B）具有请勿尝试心脏复苏文件的比例和（c）死亡时正在利物浦护理途径的比例增加。此外，患有痴呆症的体弱和老年居民的不适当医院死亡减少。然而，整体医院死亡increased.Conclusions：较低水平的护理支持管理，以维持和建立在最初的成果。然而，尽管越来越多地采用了关键的临终关怀工具，但在可持续性项目期间，医院死亡人数仍较高。虽然姑息治疗护士专家和全科医生的良好支持可以帮助确保关键流程保持到位，但稳定的管理和关键冠军对于确保姑息治疗方法融入护理之家的文化至关重要。
Background: Internationally, policy calls for care homes to provide reliably good end-of-life care. We undertook a 20-month project to sustain palliative care improvements achieved by a previous intervention.Aim: To sustain a high standard of palliative care in seven UK nursing care homes using a lower level of support than employed during the original project and to evaluate the effectiveness of this intervention.Design: Two palliative care nurse specialists each spent one day per week providing support and training to seven care homes in Scotland, United Kingdom; after death audit data were collected each month and analysed.Results: During the sustainability project, 132 residents died. In comparison with the initial intervention, there were increases in (a) the proportion of deceased residents with an anticipatory care plan in place (b) the proportion of those with Do Not Attempt Cardiopulmonary Resuscitation documentation in place and (c) the proportion of those who were on the Liverpool Care Pathway when they died. Furthermore, there was a reduction in inappropriate hospital deaths of frail and elderly residents with dementia. However, overall hospital deaths increased.Conclusions: A lower level of nursing support managed to sustain and build on the initial outcomes. However, despite increased adoption of key end-of-life care tools, hospital deaths were higher during the sustainability project. While good support from palliative care nurse specialists and GPs can help ensure that key processes remain in place, stable management and key champions are vital to ensure that a palliative care approach becomes embedded within the culture of the care home.