Department of Anaesthesia, Torbay Hospital, Torquay, Devon, UK
J Med Ethics. 2010 Sep;36(9):518-20. doi: 10.1136/jme.2009.033977.
The Treatment Escalation Plan (TEP) was introduced into our trust in an attempt to improve patient involvement and experience of their treatment in hospital and to embrace and clarify a wider remit of treatment options than the Do Not Resuscitate (DNR) order currently offers. Our experience suggests that the patient and family are rarely engaged in DNR discussions. This is acutely relevant considering that the Mental Capacity Act (MCA) now obliges these discussions to take place. The TEP is a form that the doctor completes, ideally with the competent patient or close relative, documenting what treatment options would be appropriate if that patient were to become acutely unwell. Ventilation of the lungs, cardiac resuscitation, renal replacement therapy, intravenous fluids and antibiotics are all discussed. The study evaluated patient and relative experiences with the TEP. 55 patients or their relatives were interviewed regarding their experience of the TEP and thoughts regarding the process. 96% of patients and relatives evaluated thought that the TEP was a good idea. Free text comments were all positive and only 34% of patients claimed to feel anxious when completing the form. Following this study, the TEP has been expanded hospital wide and into the community within our trust. Discussions are currently taking place in hospitals within our region to introduce the TEP form into other local trusts.
治疗升级计划（TEP）被引入我们的信托基金，旨在改善患者在医院治疗过程中的参与度和体验，并接受和明确更广泛的治疗选择范围，而不仅仅是目前的不复苏（DNR）医嘱。我们的经验表明，患者及其家属很少参与 DNR 讨论。考虑到《精神能力法案》（MCA）现在要求进行这些讨论，这一点就显得尤为重要。TEP 是医生填写的表格，理想情况下由有能力的患者或近亲填写，记录如果该患者突然病情恶化，哪些治疗选择是合适的。讨论了肺部通气、心脏复苏、肾脏替代治疗、静脉输液和抗生素等。该研究评估了患者及其家属对 TEP 的体验。对 55 名患者或其家属进行了采访，了解他们对 TEP 的体验以及对这一过程的看法。96%的患者和家属认为 TEP 是个好主意。患者填写表格时只有 34%感到焦虑。在这项研究之后，TEP 在我们的信托基金中已在全院范围内和社区范围内得到推广。目前正在我们所在地区的医院内进行讨论，以将 TEP 表格引入其他当地信托基金。
