提升加護病房善終準備及照護完整率

Improving Palliative Care in the Intensive Care Unit

現代醫療延長國人平均餘命，也延長重症末期病人痛苦死亡過程。醫護人員對善終概念及死亡前之關懷能協助家屬了解並做成決策，也可改善末期臨終照護品質，故引發筆者進行改善的動機。本專案旨在提升加護病房善終準備及照護完整率。經查檢單位發現主要問題有：（1）人員善終概念及死亡處理態度不足；（2）缺少善終相關護理指導單張；（3）善終末期照護溝通技巧不足；（4）不了解安寧共照小組及無善終標準流程等。經舉辦教育訓練提高認知；制定臨終關懷護理指導使家屬對至親往生有周全準備；會診共照小組及開家庭會議與家屬達成共識並解決問題；制定善終照護標準程序包含撤除維生醫療程序，進而將加護病房善終準備及照護完整率由7.1%提升為82.6%，達到此專案目的。

Advancement in modern medicine has increased the global average life expectancy, but prolongs suffering of terminally ill patients. It is important for medical staffs to understand the concept of palliative care in order to assist patients and families in decision-making and enhance patient quality of life. This study explores the importance of end-of-life care and identifies the weaknesses of our palliative care system in the intensive care unit (ICU). Four problems were identified in the management of care: (1) insufficient education and training of the critical care staffs; (2) lack of guidelines for symptom control and psychosocial support; (3) inadequate communication between staff members and patient/families; and (4) unfamiliar with care management and standard of care. A variety of strategies were implemented to improve ICU palliative care, which included continuous education and training of critical care professionals, establishing guidelines for critical care including withdrawal of life support, and providing support and counseling for families in times of adverse events. With this integrative approach, we have reached an improvement score from 7.1% to 82.6%.