定义和描述护理指定的不适当目标:一个10年的回顾性多中心ICU队列研究
Selena Au1, Paloma Perepeluk2, Andrea Soo1
1Department of Critical Care Medicine (S.A., A.S., J.S.), Alberta Health Services, University of Calgary, Calgary, Alberta, Canada.
Journal of pain and symptom management
|May 11, 2025
概括
不适当的护理目标 (GCD) 影响了5.7%的ICU死亡,通常是由于沟通和文档不良. 改善这些领域可以减少不适当的护理,并加强以患者为中心的决策.
科学领域:
- 医学伦理 医学伦理
- 关键护理医学 关键护理医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 护理指定的目标 (GCD) 指导了急性临床恶化期间的干预.
- 不恰当的GCD源于关于患者愿望,价值观,文档或医学有效性协议的沟通失败.
- 在ICU中不适当的GCD的患病率和原因以前是未知的.
研究的目的:
- 确定在重症监护病房 (ICU) 中不适当的护理指标 (GCD) 的频率和贡献因素.
- 为了确定与GCD不合适的患者的相关利益相关者和上下文特征.
- 为未来的质量改进举措建立基线发生率.
主要方法:
- 2010-2019年在ICU中死亡的成年患者的回顾性多中心队列研究.
- 利用现有的质量保证数据库和医生审核员标记目标的护理问题.
- 分析了4656例患者病例,其中265例符合不适当的GCD标准.
主要成果:
- 5.7% (265/4656) 的ICU死亡涉及不适当的GCD.
- 低于最佳的沟通 (44.9%),文档 (29.1%) 和利益相关者协议 (43.4%) 是关键因素.
- 在21.5%的病例中,更强烈的复苏命令发生,通常是在危机沟通或程序前的过程中.
结论:
- 经过验证的不适当的GCD定义为质量改善提供了基线发病率.
- 在沟通,文档和决策过程中的系统性改进可以减少不适当的护理.
- 这项研究强调了优化患者护理的机会,并将其与患者价值观保持一致.
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