Division of Geriatric Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
J Palliat Med. 2012 Oct;15(10):1120-3. doi: 10.1089/jpm.2011.0530. Epub 2012 Jun 12.
Despite progress towards safer care in most settings, there has been much less attention to improving safety in hospices, which care for more than 1,500,000 patients every year. In this article, we describe three serious conflicts that arise when safety measures from other settings are applied to hospice. First, safety measures that are imposed in order to reduce morbidity and mortality may be irrelevant for a hospice patient whose goals focus on comfort. Second, safety measures that are defined in patients with a life expectancy of years can be inappropriate for hospice patients whose typical survival is measured in days. Third, it can be very difficult to assign responsibility for the safety of hospice patients, whose care is provided mostly by family and friends. Therefore, generally accepted safety measures are often inappropriate for hospice care, and can lead to unintended consequences if they are applied without critical evaluation or modification. Instead, we suggest three principles that can guide the development of hospice-appropriate safety measures by considering a patient's goals and life expectancy, and the degree to which responsibility for a patient's care is shared.
尽管在大多数情况下，安全护理都取得了进展，但在临终关怀方面，人们对改善安全护理的关注要少得多，因为每年都有超过 150 万名患者在临终关怀机构接受治疗。在本文中，我们描述了将其他环境中的安全措施应用于临终关怀时出现的三个严重冲突。首先，为了降低发病率和死亡率而实施的安全措施可能与关注舒适的临终关怀患者无关。其次，对于预期寿命为数年的患者定义的安全措施可能不适合预期生存时间为数天的临终关怀患者。第三，很难为临终关怀患者的安全负责，因为他们的护理主要由家人和朋友提供。因此，通常接受的安全措施通常不适合临终关怀，并且如果在没有批判性评估或修改的情况下应用，可能会导致意外后果。相反，我们建议通过考虑患者的目标和预期寿命，以及患者护理责任的分担程度，提出三项原则，可以指导制定适合临终关怀的安全措施。
