在手术患者中未经确认的代码状态文档的发生率,这些患者在手术前有生命维持治疗 (MOLST) 的医疗订单
Jocelyn L Streid1, Annette A Wang2, Angela M Bader1
1Brigham and Women's Hospital Department of Anesthesiology, Perioperative, and Pain Medicine, Boston, MA.
Annals of surgery
|December 22, 2025
概括
在手术环境中,未经确认的患者代码状态很普遍,即使有MOLST表格等预先指示. 早期确认对于高风险患者的目标一致护理至关重要.
科学领域:
- 医学伦理 医学伦理
- 手术患者护理手术患者护理
- 医疗信息学 医疗信息学
背景情况:
- 确认患者代码状态对于术前规划至关重要,特别是对于高风险的手术患者.
- 维持生命治疗的医疗订单 (MOLST) 表格记录了患者的偏好.
- 电子健康记录 (EHR) 可能允许未经确认的代码状态命令,从而造成模两可.
研究的目的:
- 确定现有MOLST形式的手术患者中未经确认的患者代码状态的流行率.
- 分析未经确认的代码状态订单的持续时间和情况.
主要方法:
- 在一年的时间里,在第三级护理中心对手术患者进行了回顾性图表审查,这些患者先前存在MOLST形式.
- 未经确认的代码状态命令的量化频率和持续时间.
- 提取了关于订单下单背景的数据.
主要成果:
- 超过92%的患者在手术期间至少有一个未经确认的代码状态命令.
- 未确认代码状态的平均持续时间为48.7小时.
- 一半的入院患者在未经证实的代码状态下出院,许多人有MOLST表格,表明没有CPR.
结论:
- 未经证实的代码状态命令在手术患者中几乎是普遍存在的,即使是那些有记录的偏好的人.
- 尽管有提前指示,代码状态的模糊性仍然存在,这对符合目标的护理构成风险.
- 需要进行干预,以确保对脆弱的手术群体及时确认代码状态.
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