Lo S-H, Chan C-Y, Chan C-H, Sze W-k, Yuen K-K, Wong C-S, Ng T-Y, Tung Y
Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong.
Int J Palliat Nurs. 2009 Aug;15(8):384-8. doi: 10.12968/ijpn.2009.15.8.43797.
The integrated care pathway is used in end-of-life care to improve quality of care; the Liverpool Care Pathway (LCP) has been used in Europe and North America. Tuen Mun Hospital is a regional hospital in Hong Kong, China. The End-of-life Care Pathway (ECP) based on the concepts used in the Liverpool Care Pathway, was developed, with modification to suit the local condition. Criteria for entry onto the ECP were that the multidisciplinary team agreed the patient was dying, and was at least two of the following: bedbound; semi-comatose; only able to take sips of fluid; no longer able to take tablets. The ECP template replaced all other inpatient documents. The ECP was implemented in the palliative care unit for terminal cancer patients. An audit was performed to review the result. Fifty-one Chinese patients were included in the audit with mean age 64. The median duration of ECP use was 24 hours. All patients had current medication assessed and non-essential drugs were discontinued. The audit result suggested integrated care pathway in end-of-life care could be implemented successfully in an Oriental culture. The acceptance of using the ECP as a standard clinical practice takes time and education. Appropriate template design and supervision are the keys to success.
综合照护路径被用于临终关怀以提高照护质量；利物浦临终关怀路径（LCP）已在欧洲和北美使用。屯门医院是中国香港的一家区域医院。基于利物浦临终关怀路径所采用概念开发了临终关怀路径（ECP），并进行了修改以适应当地情况。进入ECP的标准是多学科团队一致认为患者处于濒死状态，且至少符合以下两项：卧床不起；半昏迷；只能小口饮水；无法再服用药片。ECP模板取代了所有其他住院文件。ECP在癌症晚期患者的姑息治疗病房实施。进行了一项审核以评估结果。51名中国患者纳入审核，平均年龄64岁。ECP使用的中位时长为24小时。所有患者的当前用药均经过评估，非必要药物停用。审核结果表明，临终关怀中的综合照护路径能够在东方文化中成功实施。将ECP用作标准临床实践的接受过程需要时间和教育。合适的模板设计和监督是成功的关键。
