Quality of Physician Orders for Life-Sustaining Treatment Forms Completed in Nursing Homes
Quality of Physician Orders for Life-Sustaining Treatment Forms Completed in Nursing Homes
复制标题
DOI：
10.1089/jpm.2016.0280
复制
发表时间：
2017-05-01
影响因子：
2.8
通讯作者：
Enguidanos, Susan
中科院分区：
文献类型：
--
作者：
Rahman, Anna N.;Bressette, Matthew;Enguidanos, Susan
背景资料：医生维持生命治疗订单（POLST）表格允许重病患者表达他们对临终治疗的偏好。尽管越来越多的POLST的使用，很少有人知道的质量完成forms.Objective：我们研究了质量的POLST形式准备的养老院居民，包括他们是否有必要的签名和临床一致的护理preferences.Design：我们进行了一个图表审查POLST形式的样本在加州的养老院居民。我们对洛杉矶13家养老院的938名居民进行了POLST审计。我们记录了POLST表格是否由患者（或代理人）和医生，以及患者关于复苏和医疗干预的治疗选择是否一致，结果：总体而言，69.6%的经审计的POLST表格至少有一个质量差的指标。大多数缺乏所需的签名（15.8%缺乏医生的签名和17.4%缺乏患者/代理人签名）和5.6%有冲突的治疗preference.Conclusion：我们发现30.4%的POLST形式的养老院居民不完整或记录临床矛盾的治疗偏好。需要提高POLST表格的质量。
Background: The physician orders for life-sustaining treatment (POLST) form allows seriously ill individuals to express their preferences for end-of-life treatments. Despite increased POLST use, little is known about the quality of completed forms.Objective: We examined the quality of POLST forms prepared for nursing home residents, including whether they had required signatures and clinically consistent care preferences.Design: We conducted a chart review of POLST forms for a sample of nursing home residents in California.Setting/Sample: We completed POLST audits for 938 residents in 13 nursing homes in Los Angeles.Measures: We recorded whether POLST forms were signed by both the patient (or proxy) and the physician, and whether the patient's treatment choices regarding resuscitation and medical intervention were consistent, as required by the California form.Results: Overall, 69.6% of audited POLST forms had at least one indicator of poor quality. Most lacked a required signature (15.8% lacked a physician signature and 17.4% lacked a patient/proxy signature) and 5.6% had conflicting treatment preferences.Conclusion: We found 30.4% of POLST forms for nursing home residents were not complete or documented clinically contradictory treatment preferences. Improvement in the quality of POLST forms is needed.