癌末病人「不施予心肺復甦術」填寫完整率之改善專案

A Project to Improve the 'Do Not Resuscitation' Consent Completeness Rate for Terminal Cancer Patients

背景：協助癌末病人選擇接受安寧緩和醫療照顧並簽署「不施予心肺復甦術」（do not resuscitation, DNR）是邁入善終的第一步，亦是癌末照顧品質指標之一，DNR填寫完整可正確傳遞訊息、確保法律效力、減少醫療疏失、並保障病人及家屬權益。自2005年5月至6月間本院癌末病人DNR填寫完整率僅33.9%，專案小組經現況分析發現問題為：(1)缺乏填寫作業標準、(2)DNR版本眾多、(3)缺乏DNR相關教育練、(4)缺乏監測制度，故成立專案小組進行改善，以提升對癌末病人之照顧品質。目的：本專案旨在提升癌末病人DNR填寫完整率由33.9%提升至80%。解決方案於2009年8月至12月執行改善策略，包括：(1)制訂填寫作業標準、(2)簡化並整合DNR版本、(3)針對醫護人員舉辦DNR相關教育訓練及(4)定期稽核。結果：癌末病人DNR填寫完整率由33.9%提升至90%。結論：此專案有效提升DNR填寫完整率，保障了病人善終之權益，並提升癌末照護品質及滿意度，可作為同儕單位進行安寧照顧之參酌。

Background: Signed do-not-resuscitate (DNR) consent is the essential first step for terminal cancer patients to choose palliative care and a quality marker of terminal care. DNR consent completeness helps deliver correct information, ensure consent legal validity, reduce medical disputes, and protect patient and family rights. The DNR consent completeness rate during May and June 2005 was only 33.9% in our hospital. Reasons indicated for this low rate included: (1) lack of a standard operating procedure for DNR consent; (2) multiple DNR consent versions; (3) lack of DNR-related education; and (4) lack of monitoring procedures. Our team developed a project to resolve these problems and improve terminal care quality. Purpose: The goal of this project was to increase the rate of DNR consent completeness from 33.9% to 80%. Resolution: The plan, implemented between August and December 2009, included the following components: (1) establish standard guidelines for DNR consent; (2) simplify and unify DNR consent procedures; (3) provide DNR education for hospital staff; and (4) establish a DNR consent monitoring system. Results: The DNR consent completeness rate rose from 33.9% to 90%. The goal of this project was thus achieved. Conclusion: This project effectively improved the DNR consent completeness rate at our hospital. The project ensured patients a good death and enhanced terminal care quality and patient satisfaction. Our experience may provide a reference to help other hospitals increase DNR their consent completeness rates.