UPMC 沙伊达德血液肿瘤科住院患者心肺复苏状态讨论和记录的标准化：PDSA 循环 1 和 2 的结果。

Standardization of Inpatient CPR Status Discussions and Documentation Within the Division of Hematology-Oncology at UPMC Shadyside: Results From PDSA Cycles 1 and 2.

机构信息

1University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA.

2University of Pittsburgh Medical Center, Palliative and Supportive Care Institute, Pittsburgh, PA.

出版信息

J Oncol Pract. 2019 Aug;15(8):e746-e754. doi: 10.1200/JOP.18.00416. Epub 2019 Jun 17.

DOI:10.1200/JOP.18.00416

PMID:31206337

Abstract

PURPOSE

In December 2016, 49% of patients admitted to inpatient oncology services at University of Pittsburgh Medical Center Shadyside Hospital had cardiopulmonary resuscitation (CPR) status discussion documentation before discharge. The aim of this project was to improve the rate of CPR status conversations.

METHODS

During Plan-Do-Study-Act (PDSA) cycle 1, a stakeholder workgroup was formed in January 2017 by oncology faculty, fellows, nurses, advance practice providers (APPs), medicine housestaff, and palliative care faculty. All oncology clinicians and inpatient team members were reminded weekly to discuss and document CPR status preferences. APPs received training on efficient and effective CPR status assessment from palliative care faculty. Oncology leadership received monthly e-mail updates of CPR status documentation rates and endorsed CPR status best practice guidelines. For PDSA cycle 2, patient charts without CPR status documentation in March 2018 were reviewed, and themes were shared with oncology leadership and reviewed with APPs.

RESULTS

After PDSA cycle 1, CPR status assessment rates increased from 49% to greater than 80%. In 2017, more than 1,500 more CPR status discussions were documented than in 2016. The percentage of patients discharged with "comfort measures only" or "do not resuscitate" orders increased from 14.2% (95% CI, 9.5% to 19.0%) to 19.8% (95% CI, 15.6% to 24.0%). For PDSA cycle 2, charts of 60 patients without CPR assessment were reviewed. Of these, 52% were admitted overnight by nocturnists and 48% by daytime APPs. Fifty-five percent of patients (n = 33 of 60) had metastatic disease. CPR status was documented on previous admissions for 53% of patients (n = 31 of 60) in the past 12 months. Fifteen percent (n = 11 of 60) were admitted for scheduled inpatient chemotherapy.

CONCLUSION

A multipronged approach significantly increased CPR status assessments. More patients transitioned to comfort measures only or do not resuscitate when their preferences were clearly assessed and documented.

摘要

目的

2016 年 12 月，匹兹堡大学医学中心沙德斯戴尔医院住院肿瘤科患者中，49%在出院前有心肺复苏（CPR）状态讨论记录。本项目旨在提高 CPR 状态讨论的比率。

方法

在计划-执行-研究-行动（PDSA）循环 1 中，2017 年 1 月由肿瘤学教师、研究员、护士、高级实践提供者（APP）、内科住院医师和姑息治疗教师组成利益相关者工作组。每周提醒所有肿瘤学临床医生和住院团队成员讨论并记录 CPR 状态偏好。APP 接受了姑息治疗教师关于高效 CPR 状态评估的培训。肿瘤学领导层每月收到 CPR 状态记录率的电子邮件更新，并认可 CPR 状态最佳实践指南。在 PDSA 循环 2 中，2018 年 3 月审查了没有 CPR 状态记录的患者病历，并与肿瘤学领导层分享主题，并与 APP 一起审查。

结果

在 PDSA 循环 1 之后，CPR 状态评估率从 49%增加到 80%以上。2017 年，记录的 CPR 状态讨论比 2016 年多 1500 多次。出院时下达“仅提供舒适护理”或“不进行心肺复苏”医嘱的患者比例从 14.2%（95%CI，9.5%至 19.0%）增加到 19.8%（95%CI，15.6%至 24.0%）。在 PDSA 循环 2 中，审查了 60 名没有 CPR 评估的患者的病历。其中，52%由夜班医生和 48%由日间 APP 收治过夜。55%的患者（n=60 名）患有转移性疾病。在过去 12 个月中，53%（n=60 名）的患者在过去的住院期间记录了 CPR 状态。15%（n=60 名）为计划中的住院化疗而入院。