Increasing the uptake of advance care directives through staff education and one-on-one support for people facing end-of-life.

IF 1.3 Q4 HEALTH CARE SCIENCES & SERVICES BMJ Open Quality Pub Date : 2024-11-02 DOI:10.1136/bmjoq-2023-002727
Leigh David Kinsman, Graeme Mooney, Gail Whiteford, Tony Lower, Megan Hobbs, Bev Morris, Kerry Bartlett, Alycia Jacob, Dan Curley
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Abstract

Background: An advance care plan outlines a patient's wishes regarding medical treatment or goals of care in the case that they become unable to communicate or to make decisions. An advance care directive (ACD) is an advance care plan that has been formally recorded and has legal status. Despite ACDs playing an important role in person-centred end-of-life care, an earlier retrospective medical records audit demonstrated that only 11% (58/531) of people who died due to a terminal illness had an ACD.The aim of this project was to increase the proportion of patients with a terminal illness completing an ACD. A secondary outcome was to measure the impact of ACDs on hospital and intensive care unit (ICU) admissions in the last 6 months of life.This multifaceted project comprised (1) education for health professionals and the public; (2) individual support for patients on request; (3) development of online resources for health professionals and the general public; and (4) monthly team meetings.

Method: The proportion of ACDs completed and hospital and ICU admissions during the last 6 months of life, were extracted via medical record audits.Written consent was required for patients to participate, including being contacted by the project team and accessing their medical records.

Results: 112 patients consented to participate in the project and 109 (97%) completed an ACD. There was no reduction in the average number of hospital admissions, while ICU admissions reduced from 14% (n=74) to 0%.

Conclusion: The targeted, multifaceted approach to education and support for completion of ACDs, resulted in a significant increase in ACD completion and a major reduction in ICU admissions.

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通过员工教育和对临终者的一对一支持,提高预先护理指令的使用率。
背景:预先护理计划概述了病人在无法沟通或无法做出决定的情况下对医疗或护理目标的愿望。预先护理指示(ACD)是一种经过正式记录并具有法律地位的预先护理计划。尽管预先护理指示在以人为本的临终关怀中发挥着重要作用,但早前的一项回顾性医疗记录审计显示,在因绝症而死亡的患者中,只有 11% (58/531)的人有预先护理指示。该项目的次要结果是衡量临终关怀对生命最后 6 个月入院和入住重症监护室(ICU)的影响。该项目涉及多个方面,包括:(1)对医疗专业人员和公众进行教育;(2)应要求为患者提供个人支持;(3)为医疗专业人员和公众开发在线资源;以及(4)每月举行团队会议:方法:通过病历审核提取患者在生命最后 6 个月内完成 ACD 的比例以及入院和入住重症监护病房的情况:112名患者同意参与该项目,其中109人(97%)完成了ACD。平均入院次数没有减少,而入住重症监护室的比例从 14%(74 人)降至 0%:有针对性的、多方面的教育和支持方法使完成 ACD 的人数显著增加,ICU 入院人数大幅减少。
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来源期刊
BMJ Open Quality
BMJ Open Quality Nursing-Leadership and Management
CiteScore
2.20
自引率
0.00%
发文量
226
审稿时长
20 weeks
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