The last 48 hours of life in long-term care: A focused chart audit
The last 48 hours of life in long-term care: A focused chart audit
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DOI：
10.1046/j.1532-5415.2002.50117.x
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发表时间：
2002-03-01
影响因子：
6.3
通讯作者：
Weaver, L
中科院分区：
文献类型：
--
作者：
Hall, P;Schroder, C;Weaver, L
目的：作为姑息治疗教育项目开发的一个组成部分，渥太华大学姑息治疗研究所的教师希望评估长期护理（LTC）环境中患者的临终关怀，以制定医生的教育策略。设计：一个图表审计，关注在LTC设施中死亡的居民生命的最后48小时。12个月内在LTC设施中死亡的居民。那些突然死亡的人（即，没有缓解期）或在医院中被排除。测量：在文献中突出显示的症状在末期疾病和匹配的治疗中常见，并记录在由作者创建的审计表上。包括疼痛，呼吸困难，嘈杂的呼吸，谵妄，吞咽困难，发热，肌阵挛。大量患者存在认知障碍。癌症是14%病例的子诊断。呼吸道症状是最常见的症状，呼吸困难是第一位，嘈杂的呼吸第三位。疼痛排在第二位，患病率与癌症患者研究中发现的相似。23%的呼吸困难患者未接受治疗;仅27%的呼吸困难患者使用阿片类药物。99%的疼痛患者接受了治疗，只有不到三分之一的呼吸噪音患者接受了治疗。在38%的病例中，谵妄未得到治疗，也未给予抗多巴胺能药物。护士主要负责记录结束的生活问题，支持垂死的居民的家庭，并与其他团队members.CONCLUSION：重点图表审计确定了高患病率的认知障碍的患者人群，这使症状管理复杂化。呼吸道症状在生命的最后48小时内占主导地位。这种症状不同于癌症患者，根据文献，癌症患者有更多的疼痛和更少的呼吸困难。症状的管理是可变的。护士通过记录和沟通临终问题，在护理临终居民方面发挥了至关重要的作用。适当的姑息治疗教育可以为所有医疗保健专业人员（包括医生）提供知识和技能，并帮助他们控制在LTC设施中死亡的患者的症状和改善生活质量。
OBJECTIVES: As a component of palliative care educational program development, the faculty at the University of Ottawa Institute of Palliative Care wished to assess end-of-life care for patients in long-term care (LTC) settings to develop an educational strategy for physicians.DESIGN: A chart audit, focusing on the last 48 hours of life of residents dying in LTC facilities.SETTING: Five LTC facilities in a city in Canada.PARTICIPANTS: Residents who died in the LTC facilities in a 12-month Period. Those who died suddenly (i.e., with no palliation period) or in a hospital were excluded.MEASUREMENTS: Symptoms highlighted in the literature as commonly found in the terminally ill and the matching treatments were recorded on an audit form created by the authors. Included were pain, dyspnea, noisy breathing, delirium, dysphagia, fever, and myoclonus.RESULTS: One hundred eighty-five charts were reviewed. A large number of patients were cognitively impaired. Cancer was the filial diagnosis in 14% of cases. Respiratory symptoms were the most prevalent symptom with dyspnea being first and noisy breathing third. Pain was second, with a prevalence similar to that found in studies of cancer patients. Dyspnea was not treated in 23% of the patients with this symptom; opioids were used in only 27% of cases with dyspnea. Ninety-nine percent of patients who experienced pain were treated for it. Less than one-third of patients with noisy breathing were treated. Delirium was not treated in 38% of the cases, and no anti-dopaminergic medications were administered. Nurses were primarily responsible for documenting end-of-life issues, supporting the families of the dying residents, and communicating with other team members.CONCLUSION: The focused chart audit identified the high prevalence of cognitive impairment in the patient population, which complicates symptom management. Respiratory symptoms predominated in the last 48 hours of life. This symptom profile differs from that of cancer patients, who, according to the literature, have more pain and less respirator), trouble. Management of symptoms was variable. Nurses played a crucial role in the care of dying residents through their documentation and communication of end-of-life issues. Appropriate palliative care education can provide knowledge and skills to all healthcare professionals, including physicians, and assist them in the control of symptoms and improvement of quality of life for patients dying in LTC facilities.