提升內科病房生命末期病人善終準備完整率

Improving the Integrity of End-of-Life-Care Preparations for Terminally-lll Patients in the Medical Ward

醫療科技的進步雖延長國人平均餘命，控制許多急、慢性病惡化，卻無法避免疾病進展為末期及面臨死亡，因此如何提升末期病人的生活品質，使其有尊嚴、安詳的離世，成為照護此類病人的重要議題。本病房 2018 年度接受非預期性心肺復甦的末期病人由 3 位增加為 8 位，急救成功者僅 2 位，病人在生命末期時，飽受醫療維生儀器侵入之苦而無法善終，引發改善動機，故專案目的旨在提升內科病房末期病人善終準備完整率。經調查分析原因：護理人員善終照護認知不足、末期照護溝通技巧不足、衛教單張繁瑣、未有系統交班已作項目，且無充足宗教用品。藉由在職教育，製訂衛教單張及溝通語錄，擬訂流程標準化及交班內容，設置善終百寶箱及查核制度，將善終準備完整率由 18.2% 提升為 83.3%，達專案目的。讓善終成為對病人的最後祝福，對家屬的最大慰藉，達生死兩相安。

Death is inevitable no matter how medical technology has been improving. It is important to improve the quality of life in terminally ill patients and help them end their life in peace with dignity. In our ward, the number of patients at the end-of-life receiving cardiopulmonary resuscitation increased from three to eight in 2018, and only two were successfully rescued. The patients usually suffered unnecessary impact of aggressive interventions at the end of life. The purpose of this project was to improve the integrity of end-of-life-care preparations in the medical ward. Five problems were identified in the management of care: (1) lack of knowledge about providing appropriate care to end-of-life patients; (2) insufficient communication between staff members and patient/families on end-of-life care; (3) teaching guidance was too complicated; (4) inadequate systematic hand-off reporting; and (5) lack of sufficient religion related items. A variety of strategies was implemented to improve the integrity of end-of-life care, including providing continuous educational and training programs, creating health education leaflets and communication quotations, and developing a standard of care and hand-off reporting protocol. With the implementation of the project, the integrity of end-of-life careincreased from 18.2% to 83.3%. The hospice is the last blessing to the patient. It provides comprehensive comfort to the family and tranquility to the patient at the end of life.