Improving processes of hospital care during the last hours of life
Improving processes of hospital care during the last hours of life
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DOI：
10.1001/archinte.165.15.1722
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发表时间：
2005-08-08
影响因子：
--
通讯作者：
Goode, PS
中科院分区：
文献类型：
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作者：
Bailey, FA;Burgio, KL;Goode, PS
背景：临终关怀项目以在生命最后几天和几小时提供卓越的护理而闻名，可以帮助个人“安乐死”，并提高家庭对护理质量的满意度。我们的目的是评估基于家庭临终关怀最佳实践的多成分姑息治疗干预措施的有效性，旨在提高为在急症护理住院环境中死亡的患者提供的护理质量。方法：本研究是 2001 年至 2003 年间进行的干预前后试验。参与者包括城市三级护理退伍军人事务医疗中心住院服务的医生、护理人员和辅助人员。姑息治疗干预措施包括对工作人员进行教育和支持，以识别即将死亡的患者，并在生命的最后几天或几小时内实施以舒适护理指令集模板为指导的护理计划。从干预前 (n = 108) 和干预后 (n = 95) 6 个月期间死亡的 203 名退伍军人的计算机医疗记录中提取的数据用于确定干预对症状记录和 5 个护理指标过程的影响。结果：记录的症状平均 (SD) 数量从 1. 7 (2.1) 显着增加到 4.4 (2.7) (P < .001)，护理计划数量也显着增加从 0.4 (0.9) 增加到 2.7 (2.3) (P < .001)。阿片类药物的可用性从 57.1% 增加到 83.2% (P < .001)，不复苏指令从 61.9% 增加到 85.1% (P < .001)。重症监护病房 (P = . 17) 和鼻胃管使用 (P = . 40) 的死亡比例没有显着变化，而约束装置的使用显着增加 (P < .001)。结论：我们的结果表明，引入姑息治疗计划后，临终关怀有所改善。
Background: Known for excellence in care in the last days and hours of life, hospice programs can help individuals have a "good death" and lead to higher family satisfaction with quality of care. Our objective was to evaluate the effectiveness of a multicomponent palliative care intervention based on the best practices of home hospice and designed to improve the quality of care provided for patients dying in an acute care inpatient setting.Methods: This study was a before-after intervention trial conducted between 2001 and 2003. Participants included physician, nursing, and ancillary staff on inpatient services of an urban, tertiary care Veterans Affairs medical center. The palliative care intervention included staff education and support to identify patients who were actively dying and implement care plans guided by a comfort care order set template for the last days or hours of life. Data abstracted from computerized medical records of 203 veterans who died during a 6-month period before (n = 108) and after (n = 95) intervention were used to determine the impact of intervention on symptom documentation and 5 process of care indicators.Results: There was a significant increase in the mean (SD) number of symptoms documented from 1. 7 (2.1) to 4.4 (2.7) (P < .001), and the number of care plans increased from 0.4 (0.9) to 2.7 (2.3) (P < .001). Opioid medication availability increased from 57.1% to 83.2% (P < .001), and do-not-resuscitate orders increased from 61.9% to 85.1% (P < .001). There were nonsignificant changes in the proportion of deaths that occurred in intensive care units (P =. 17) and in the use of nasogastric tubes (P =. 40), and there was a significant increase in the use of restraints (P < .001).Conclusion: Our results indicate that end-of-life care improved after the introduction of the palliative care program.