Hartle Gerald A, Thimons David G, Angelelli Joseph
Heritage Valley Family Practice, 2620 Constitution Boulevard, Beaver Falls, PA 15010, USA.
School of Nursing and Health Sciences, Robert Morris University, 6001 University Boulevard, Moon Township, PA 15108, USA.
Nurs Res Pract. 2014;2014:761784. doi: 10.1155/2014/761784. Epub 2014 Apr 29.
This case study describes changes in Physician Orders for Life Saving Treatment (POLST) status among long-stay residents of a US nursing home who had a certified registered nurse practitioner (CRNP) adopt the practice of participating in nursing home staff care plan meetings. The CRNP attended a nonrandomized sample of 60 care plan meetings, each featuring a review of POLST preferences with residents and/or family members. Days since original POLST completion, Charlson Comorbidity Index score, number of hospitalizations since index admission, and other sociodemographic characteristics including religion and payer source were among the data elements extracted via chart review for the sample as well as for a nonequivalent control group of 115 residents also under the care of the medical provider group practice at the nursing home. Twenty-three percent (n = 14) of the 60 care conferences attended by the CRNP resulted in a change in POLST status after consultations with the resident and/or family. In all cases, POLST changes involved restated preferences from a higher level of intervention to a lower level of intervention. Fifty-nine percent of the CRNP-attended conferences resulted in the issuance of new medical provider orders. CRNP participation in care conferences may represent a best practice opportunity to revisit goals of care with individuals and their family members in the context of broader interprofessional treatment planning.
本案例研究描述了美国一家疗养院长期居住居民的“医生下达的维持生命治疗医嘱”（POLST）状态的变化，这些居民中有一名认证注册护士从业者（CRNP）开始参与疗养院工作人员护理计划会议。该CRNP参加了60次护理计划会议的非随机样本，每次会议都与居民和/或家庭成员一起回顾了POLST偏好。自最初完成POLST以来的天数、查尔森合并症指数评分、自入院以来的住院次数，以及包括宗教和付款来源在内的其他社会人口特征，都是通过图表审查从样本以及疗养院医疗服务提供者团队护理的115名居民的非等效对照组中提取的数据元素。在CRNP参加的60次护理会议中，23%（n = 14）在与居民和/或家庭协商后导致了POLST状态的改变。在所有情况下，POLST的改变都涉及将偏好从较高水平的干预调整为较低水平的干预。在CRNP参加的会议中，59%的会议导致发布了新的医疗服务提供者医嘱。CRNP参与护理会议可能是一个最佳实践机会，可在更广泛的跨专业治疗计划背景下，与个人及其家庭成员重新审视护理目标。
