与中风患者的姑息关怀沟通:最佳实践实施项目。

IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Jbi Evidence Implementation Pub Date : 2024-03-15 DOI:10.1097/XEB.0000000000000414
Ashley Brook Schaefer, Candon Garbo, Michelle Palokas
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引用次数: 0

摘要

导言脑卒中患者经常会出现衰弱性功能缺失,有些患者会被诊断为晚期。姑息关怀服务的引入是为了优先照顾患者,以改善其生活质量。然而,姑息关怀沟通(PCC)在中风患者中往往被延迟或使用效率低下:本项目旨在向中风患者推广姑息关怀沟通的循证实践(EBPs):方法:该项目使用 JBI 证据实施框架来提高美国密西西比州一家医疗中心的卒中患者对 PCC EBPs 的依从性。从 JBI 证据摘要中确定了四项 EBP,并将其作为审核标准。进行了基线审核,以衡量当前实践是否符合最佳实践。确定了 EBPs 的障碍,实施了改进策略,并进行了后续审计以确定遵守情况的变化:结果:基线审计显示,四种 EBPs 的合规率为 53%至 80%。EBPs 的障碍包括:医护人员对 EBPs 缺乏了解;缺乏 PCC、沟通不畅或延迟与患者就住院时间和生活质量进行 PCC;电子病历中没有标准化的 PCC 文档或位置。改进策略包括为医护人员开展 PCC 教育计划,在电子病历的 "进展记录 "中加入简明的声明和验证复选框,以促进与患者的日常 PCC。后续审计显示,采用 EBPs 的依从率提高了 20% 至 34%:结论:应每年对医护人员进行 PCC 培训。通过多学科方法实施PCC可促进更有意义的讨论和更有效的决策,优先考虑患者的生活质量。西班牙文摘要:http://links.lww.com/IJEBH/A174。
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Palliative care communication with stroke patients: a best practice implementation project.

Introduction: Stroke patients frequently experience debilitating deficits, and some receive a terminal diagnosis. Palliative care services are introduced to prioritize care, with the goal of improving quality of life. However, palliative care communication (PCC) is often delayed or used inefficiently with stroke patients.

Objectives: This project aimed to promote PCC evidence-based practices (EBPs) with stroke patients.

Methods: This project used the JBI Evidence Implementation Framework to improve compliance with PCC EBPs with stroke patients in a medical center in Mississippi, USA. Four EBPs were identified from a JBI evidence summary and used as audit criteria. A baseline audit was conducted to measure compliance of current practice with best practice. Barriers to EBPs were identified, improvement strategies were implemented, and a follow-up audit was conducted to determine compliance changes.

Results: The baseline audit revealed 53% to 80% compliance with the four EBPs. Barriers to EBPs included lack of health care professionals' knowledge regarding EBPs; lack of PCC, miscommunication, or delayed PCC with patients regarding hospitalization timeline and quality of life; and no standardized documentation or location for PCC within the electronic health record. Improvement strategies included a PCC education program for health care professionals and a concise statement and validation checkbox to the "progress note" in the electronic health record to promote daily PCC with patients. The follow-up audit revealed 20% to 34% compliance rate improvement with EBPs.

Conclusions: Annual PCC training should be conducted for health care professionals. Implementing PCC through a multidisciplinary approach can promote more meaningful discussion and efficient decision-making, prioritizing patients' quality of life.

Spanish abstract: http://links.lww.com/IJEBH/A174.

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来源期刊
CiteScore
3.20
自引率
13.00%
发文量
23
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