From the Department of Palliative Medicine, LMU Munich, University Hospital, Munich, Germany.
J Patient Saf. 2022 Jun 1;18(4):e801-e809. doi: 10.1097/PTS.0000000000000918.
Continuous infusions of sedatives and/or opioids (continuous infusions) are frequently used in end-of-life care. Available data indicate challenges in nonspecialist palliative care settings. We aimed to assess the use of continuous infusions during the last week of life in different hospital departments.
In a sequential mixed-methods design, a retrospective cohort study was followed by consecutive qualitative interviews in 5 German hospital departments. Medical records of 517 patients who died from January 2015 to December 2017 were used, and 25 interviews with physicians and nurses were conducted. Recorded sedatives were those recommended in guidelines for "palliative sedation": benzodiazepines, levomepromazine, haloperidol (≥5 mg/d), and propofol. Exploratory statistical analysis (R 3.6.1.) and framework analysis of interviews (MAXQDA 2018.2) were performed.
During the last week of life, 359 of 517 deceased patients (69%) received continuous infusions. Some interviewees reported that continuous infusions are a kind of standard procedure for "palliative" patients. According to our interviewees' views, equating palliative care with continuous infusion therapy, insufficient experience regarding symptom control, and fewer care needs may contribute to this approach. In addition, interviewees reported that continuous infusions may be seen as an "overall-concept" for multiple symptoms. Medical record review demonstrated lack of a documented indication for 80 of 359 patients (22%). Some nurses experienced concerns or hesitations among physicians regarding the prescription of continuous infusions.
Continuous infusions seem to be common practice. Lack of documented indications and concerns regarding the handling and perception of a "standard procedure" in these highly individual care situations emphasize the need for further exploration and support to ensure high quality of care.
在生命末期护理中，经常使用镇静剂和/或阿片类药物的持续输注（连续输注）。现有数据表明，在非专科姑息治疗环境中存在挑战。我们旨在评估不同医院科室在生命最后一周使用连续输注的情况。
采用顺序混合方法设计，在 5 个德国医院科室进行回顾性队列研究后，紧接着进行连续定性访谈。使用了 2015 年 1 月至 2017 年 12 月期间死亡的 517 名患者的病历，对 25 名医生和护士进行了访谈。记录的镇静剂是指南中推荐用于“姑息镇静”的镇静剂：苯二氮䓬类、左美丙嗪、氟哌啶醇（≥5mg/d）和丙泊酚。进行了探索性统计分析（R 3.6.1.）和访谈的框架分析（MAXQDA 2018.2）。
在生命的最后一周，517 名死者中有 359 名（69%）接受了连续输注。一些受访者报告说，连续输注是“姑息”患者的一种标准程序。根据受访者的观点，将姑息治疗等同于连续输注治疗、对症状控制经验不足以及护理需求较少可能促成了这种方法。此外，受访者报告说，连续输注可能被视为多种症状的“整体概念”。病历审查显示，359 名患者中有 80 名（22%）缺乏记录的适应症。一些护士对医生开具连续输注的处方表示关注或犹豫不决。
连续输注似乎是一种常见做法。缺乏记录的适应症以及对这些高度个体化护理情况下的“标准程序”的处理和感知的担忧，强调需要进一步探索和支持，以确保高质量的护理。
