School of Nursing, Columbia University, New York, NY, USA.
RAND Corporation, Santa Monica, CA, USA.
Palliat Med. 2020 May;34(5):580-588. doi: 10.1177/0269216320902672. Epub 2020 Mar 10.
Infections are common occurrences at end of life that are associated with high rates of morbidity and mortality among frail elderly individuals. The problem of infections in nursing homes has led to a subsequent overuse and misuse of antibiotics in this already-frail population. Improving palliative care in nursing homes has been proposed as a key strategy to reduce the use of antibiotics.
The aim of this study was to describe the current status of how nursing homes integrates palliative care and infection management at end of life across the nation.
This is a cross-sectional survey of nationally representative US nursing homes.
SETTING/PARTICIPANTS: Between November 2017 and October 2018, a survey was conducted with a nationally representative random sample of nursing homes and 892 surveys were completed (49% response rate). The weighted study sample represented 15,381 nursing homes across the nation.
Most nursing homes engaged in care plan documentation on what is important to residents (90.43%) and discussed spiritual needs of terminally ill residents (89.50%). In the event of aspiration pneumonia in terminally ill residents, 59.43% of nursing homes responded that resident would be transferred to the hospital. In suspected urinary tract infection among terminally ill residents, 66.62% of nursing homes responded that the resident will be treated with antibiotics.
The study found wide variations in nursing home palliative care practices, particularly for timing of end-of-life care discussions, and suboptimal care reported for antibiotic usage. Further education for nursing home staff on appropriate antibiotic usage and best practices to integrate infection management in palliative care at the end of life is needed.
感染在生命末期很常见，与体弱老年人的高发病率和死亡率有关。养老院的感染问题导致了在这个已经体弱的人群中抗生素的过度使用和滥用。改善养老院的姑息治疗被认为是减少抗生素使用的关键策略。
本研究旨在描述全国范围内养老院在生命末期如何整合姑息治疗和感染管理的现状。
这是一项对全国有代表性的美国养老院进行的横断面调查。
地点/参与者：在 2017 年 11 月至 2018 年 10 月期间，对全国有代表性的养老院进行了一项随机抽样调查，共完成了 892 份调查（49%的回复率）。加权研究样本代表了全国 15381 家养老院。
大多数养老院都在护理计划中记录了对居民重要的内容（90.43%），并讨论了临终居民的精神需求（89.50%）。在临终居民发生吸入性肺炎的情况下，59.43%的养老院会将患者转院。在临终居民疑似尿路感染的情况下，66.62%的养老院会给患者使用抗生素治疗。
研究发现养老院姑息治疗实践存在广泛差异，特别是在临终关怀讨论的时机方面，抗生素使用方面的护理并不理想。需要对养老院工作人员进行有关抗生素使用和最佳实践的进一步教育，以在生命末期将感染管理纳入姑息治疗。
