A prospective study of the efficacy of the physician order form for life-sustaining treatment
A prospective study of the efficacy of the physician order form for life-sustaining treatment
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DOI：
10.1111/j.1532-5415.1998.tb06647.x
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发表时间：
1998-09-01
影响因子：
6.3
通讯作者：
Dunn, PM
中科院分区：
文献类型：
--
作者：
Tolle, SW;Tilden, VP;Dunn, PM
目的：生命维持治疗医嘱（POLST）是一个综合性的单页订单，旨在传达从一个护理站点转移到另一个护理站点期间对生命维持治疗的偏好。本研究探讨了POLST形式确保养老院居民的意愿得到尊重的程度不复苏（DNR）和转移的要求，只有当舒适措施ful.Design：本研究使用图表记录数据，前瞻性地遵循一个样本的养老院居民与POLST.SETTING：八个地理位置不同，长期，成人护理设施在俄勒冈州，其中POLST是在使用。疗养院居民（n = 180），谁有一个POLST记录DNR指定和谁表示转移的愿望，只有当舒适的措施失败，被跟踪为1 year.MEASUREMENTS：对于所有受试者：治疗和处置后，显着的健康状况的变化，麻醉品和提供或限制积极的干预措施的订单。对于住院受试者：诊断、医疗干预和DNR医嘱。对于那些死去的人：死亡原因和位置，生命维持治疗尝试，并提供舒适measurements provided.结果：没有研究对象接受心肺复苏术，ICU护理，或呼吸机支持，只有2%的人住院延长生命。在研究年内死亡的38例受试者中，63%有麻醉剂订单，只有2例（5%）在急性护理医院死亡。年内共有24例受试者（13%）住院。住院受试者的平均住院时间为4.9天，所有受试者的平均住院率为174/1000住院年。在85%的住院病人中，病人被转移是因为疗养院无法控制痛苦。在15%的住院治疗（n = 4），转移是为了延长生命，推翻POLST orders.CONCLUSIONS：POLST订单在这项研究中的疗养院居民心肺复苏术普遍尊重。研究对象接受了非常高水平的舒适护理和低转移率的积极延长寿命的治疗。
OBJECTIVES: The Physician Orders for Life-Sustaining Treatment (POLST), a comprehensive, one-page order form, was developed to convey preferences for life-sustaining treatments during transfer from one care site to another. This study examined the extent to which the POLST form ensured that nursing home residents' wishes were honored for Do Not Resuscitate (DNR) and requests for transfer only if comfort measures fail.DESIGN: The study used chart record data to follow prospectively a sample of nursing home residents with the POLST.SETTING: Eight geographically diverse, long-term, adult-care facilities in Oregon in which the POLST was in use.PARTICIPANTS: Nursing home residents (n = 180), who had a POLST recording DNR designation and who indicated a desire for transfer only if comfort measures failed, were followed for 1 year.MEASUREMENTS: For all subjects: treatment and disposition after significant health status changes; orders for narcotics and for provision or limitation of aggressive interventions. For hospitalized subjects: diagnosis, medical interventions, and DNR orders. For those who died: cause and location of death, life-sustaining treatments attempted, and comfort measures provided.RESULTS: No study subject received CPR, ICU care, or ventilator support, and only 2% were hospitalized to extend life. Of the 38 subjects who died during the study year, 63% had an order for narcotics, and only two (5%) died in an acute care hospital. A total of 24 subjects (13%) were hospitalized during the year. Hospitalized subjects' mean length of stay was 4.9 days, and the mean rate of hospitalizations for all subjects was 174 per 1000 resident years. In 85% of all hospitalizations, patients were transferred because the nursing home could not control suffering. In 15% of hospitalizations (n = 4), the transfer was to extend life, overriding POLST orders.CONCLUSIONS: POLST orders regarding CPR in nursing home residents in this study were universally respected. Study subjects received remarkably high levels of comfort care and low rates of transfer for aggressive life-extending treatments.