Wind Annet W, Gercama Ale J
Leids Universitair Medisch Centrum, afd. Public Health en Eerstelijnsgeneeskunde, Leiden, The Netherlands.
Ned Tijdschr Geneeskd. 2010;154:A1763.
In January 2010, the Royal Dutch Medical Association (KNMG) will publish the guideline 'Sharing responsibilities when cooperating in cure and care'. However, in practice the situation is a long way off from the ideal outlined in the guideline. The ideal situation for a patient in need of complex care would be to have coordination and case management in the hands of one person, but in practice, several care providers are involved. The physician has the final medical responsibility and should maintain an overview. The care coordinator is the person who ensures the other care providers keep to the arrangements made. The case manager is the one who has frequent contact with the patient and relatives. This requires sound working agreements and adequate, timely exchange of information between care providers themselves and between care providers and the patient. Working with care plans contributes to this exchange of information and should become routine.
2010年1月，荷兰皇家医学协会（KNMG）将发布指南《治疗与护理合作中的责任分担》。然而，在实际情况中，距离该指南所概述的理想状况还有很长的路要走。对于需要复杂护理的患者而言，理想情况是由一人负责协调和病例管理，但实际上涉及到多个护理提供者。医生承担最终的医疗责任，应全面掌控情况。护理协调员负责确保其他护理提供者遵守所做的安排。病例管理员则是与患者及其亲属保持频繁联系的人。这需要完善的工作协议，以及护理提供者之间、护理提供者与患者之间充分且及时的信息交流。使用护理计划有助于这种信息交流，并且应成为常规做法。
