Clinical Resource Management, Palomar Health, USA.
Omega (Westport). 2013;67(1-2):43-51. doi: 10.2190/OM.67.1-2.e.
A transdisciplinary team is an essential component of palliative and end-of-life care. This article will demonstrate how to develop a transdisciplinary approach to palliative care, incorporating nursing, social work, spiritual care, and pharmacy in an acute care setting. Objectives included: identifying transdisciplinary roles contributing to care in the acute care setting; defining the palliative care model and mission; identifying patient/family and institutional needs; and developing palliative care tools. Methods included a needs assessment and the development of assessment tools, an education program, community resources, and a patient satisfaction survey. After 1 year of implementation, the transdisciplinary palliative care team consisted of seven palliative care physicians, two social workers, two chaplains, a pharmacist, and End-of-Life Nursing Consortium (ELNEC) trained nurses. Palomar Health now has a palliative care service with a consistent process for transdisciplinary communication and intervention for adult critical care patients with advanced, chronic illness.
跨学科团队是姑息治疗和临终关怀的重要组成部分。本文将展示如何在急性护理环境中采用跨学科方法来提供姑息治疗，将护理、社会工作、精神关怀和药学纳入其中。目标包括：确定在急性护理环境中有助于护理的跨学科角色；定义姑息治疗模式和使命；确定患者/家庭和机构的需求；并开发姑息治疗工具。方法包括需求评估和评估工具的开发、教育计划、社区资源和患者满意度调查。实施一年后，跨学科姑息治疗团队由七名姑息治疗医生、两名社会工作者、两名牧师、一名药剂师和接受过 End-of-Life Nursing Consortium (ELNEC) 培训的护士组成。现在，帕洛玛健康中心有了姑息治疗服务，为患有晚期、慢性疾病的成年重症监护患者提供跨学科沟通和干预的一致流程。
