提升重症呼吸末期病人接受安寧緩和醫療比率之專案

An Improvement Project for Hospice-Palliative Coverage Rate among Critically Ill Patients with Terminal Respiratory Disease

醫療技術精進，使得重症病人延長生命，而這類病人為多重器官衰竭，甚至癌症末期，因此推行重症緩和醫療的觀念，讓末期病人免除死亡前的痛苦是很重要的。本病房主要收治呼吸器依賴病人，其中重症呼吸末期病人接受安寧緩和醫療比率只有38.6%，引發改善動機，原因調查為缺乏安寧共同照護的評估工具、病人或家屬疾病認知與醫師判斷不一致、未提供安寧緩和醫療相關文宣、缺乏安寧緩和醫療教育訓練，經討論後解決方案有召開家庭會議提供緩和醫療訊息、錄製重症呼吸末期安寧療護影片檔、制定重症呼吸末期病人安寧共同照護指引及評估表、App-QR Code下載安寧緩和相關說明、舉辦在職教育等，讓安寧緩和醫療比率上升至65.3%，進而提升重症末期照護品質。

Advanced medical technology has increased the life span of critically ill patients. However, such patients are characterized by multiple organ failure and even terminal cancer. Therefore, it is extremely important to promote the concept of palliative care, enabling terminally ill patients to be free from suffering before dying. The study ward mainly admitted ventilator-dependent patients, among whom the hospice-palliative coverage rate for critically ill patients with terminal respiratory disease was only 38.6%. The reasons were identified as follows: lack of hospice shared care assessment tool, inconsistency between patients or family members’ disease knowledge and physician diagnosis, lack of hospice-palliative care brochures, and lack of hospice-palliative care education and training program. Intervention strategies included as follows: (1) holding family meetings to provide information about hospice-palliative care, (2) making patient education video for critically ill patients with terminal respiratory disease, (3) designing a hospice shared care assessment form and a hospice shared care guidance for critically ill patients with terminal respiratory disease, (4) Instructing the use of downloading App-QR Code for hospice-palliative care related information, and (5) arranging in-service education. The hospice-palliative coverage rate increased to 65.3%, which thereby improved the quality of end-of-life care for critically ill patients.