Hyatt Raymond, Dean John, O'Neill Marie, Patel Nikesh, Abu-Rabia Mustafa, Taylor Joanne
East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK.
Salford Royal NHS Foundation Trust, Salford, UK.
Future Healthc J. 2018 Feb;5(1):10-14. doi: 10.7861/futurehosp.5-1-10.
Managing patients with frailty is an increasing element of acute hospital care, constituting around 40% of acute hospital inpatients. Up to half of these patients may be approaching the end of their life, and many also have repeated hospital admissions. We therefore undertook a quality improvement project to help us identify the prevalence of frail older inpatients approaching end of life and to better identify these patients in advance. We also developed and evaluated a pro forma to assist in initiating an advance care planning conversation with the patient and/or family. Fifty percent of our frail older inpatients were assessed as approaching end of life. Factors identifying older inpatients as more likely to die during the hospital admission included residence in a care home, two or more hospital admissions over the preceding 12 months, and a diagnosis of some form of dementia for more than 3 years. A novel goals and priorities of care (GPOC) document was found to support and guide palliative care conversations. Acute hospital care could be organised more effectively to recognise the potential need for palliative care in frail older patients. Identifying those at higher risk and using structured interviews and documentation is helpful, ultimately resulting in more appropriate care. Well-developed communication skills are needed for these complex care planning conversations.
管理体弱患者是急性医院护理中日益重要的组成部分，约占急性医院住院患者的40%。这些患者中多达一半可能已接近生命末期，而且许多人还多次入院。因此，我们开展了一项质量改进项目，以帮助我们确定接近生命末期的体弱老年住院患者的患病率，并提前更好地识别这些患者。我们还制定并评估了一份模板，以协助启动与患者和/或家属的预先护理计划谈话。我们50%的体弱老年住院患者被评估为接近生命末期。将老年住院患者认定为在住院期间更有可能死亡的因素包括居住在养老院、在过去12个月内有两次或更多次入院，以及患有某种形式的痴呆症超过3年。一份新颖的护理目标和优先事项（GPOC）文件被发现有助于支持和指导姑息治疗谈话。可以更有效地组织急性医院护理，以认识到体弱老年患者对姑息治疗的潜在需求。识别高危患者并采用结构化访谈和文件记录是有帮助的，最终可实现更恰当的护理。进行这些复杂的护理计划谈话需要具备良好的沟通技巧。
