提升安寧共同照護模式收案率專案－－以南部某區域醫院為例

The improvement project of the utility of the hospice shared-care: A Case of a regional hospital in Southern Taiwan

台灣地區每年約三萬五仟人因癌症而死亡，病患適切的臨終關懷服務顯得更加重要。本院因應癌末醫療體系發展所需於96年全院推展安寧共同照護，但收案率始終未見理想，因此欲透過本專案探討原因並進行改善，以提升安寧共照收案率。本專案自民國97年1月15日至7月30日止，共進行6個半月時間，分別依計畫期、執行期、評值期等三個時期進行。由分析中發現收案率不佳的原因主要為：（1）無標準收案流程、（2）表單不齊、（3）醫護人員缺乏安寧照護知識以及（4）政策缺乏宣導，故本專案小組透過（1）制訂收案流程與明定工作責任歸屬、（2）制訂各項表單、（3）舉辦在職教育以及（4）各科室宣導執行方案等策略進行改善。結果發現收案率由改善前14%提升到87%，達到明顯改善之效果。

There are approximately thirty five thousand people died due to cancer per year in Taiwan and patients’ hospice care is more important by time. To follow the development of cancer health system, this hospital has implemented the model of hospice shared-care at 2007, but the performance was not ideal. This object of the project was to address this situation by examining the reasons and providing solutions to improve the rate of cases enrolled. The project launched from January 15 to July 30 at 2008, a total of 6.5 months which included the plain period, implementation period, and evaluation period, respectively. We have found the major reasons to induce low utility rate of hospice shared-care, including (1) lacking a standard operation process, (2) lacking the forms used in the process, (3) the relevant members’ knowledge with hospice shared-care was insufficient, and (4) lacking to advocate the policy. Therefore the group members improved these through certain tactics: (1) to make a standard operation process and accountability, (2) to make the forms needed to use in the process, (3) to hold the training courses, and (4) to promote the policy for all departments. The results showed the utility rate of hospice shared-rate was improved significantly, that is, it was rising from 14% to 87%.