改善末期肝病患者入院息护理的机会:质量改进项目
Elvina Ward1, Georgina Hanbury2, Lucia Possamai2
1St Mary's Hospital, London, UK elvina-ward@hotmail.com.
BMJ open quality
|December 22, 2025
概括
实施肝病支持性和息性护理指标工具 (SPICT) 改善了末期肝病 (ESLD) 患者的息性护理 (PC) 获取. 然而,需要进一步改进,以充分解决这一群体中未得到满足的PC需求.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 抚慰性护理是一种缓解性护理.
- 提高质量 提高科学 提高质量
背景情况:
- 末期肝病 (ESLD) 在英国预后不佳,死亡率上升.
- 患有ESLD的患者通常有未满足的息治疗 (PC) 需求,这是由于预后预测和专业息治疗 (SPC) 转诊的挑战.
- 为了解决这些未得到满足的需求,启动了一项质量改进 (QI) 项目.
研究的目的:
- 评估和加强ESLD和未满足需求的住院患者获得PC的机会.
- 评估支持性和息性护理指标工具 (SPICT) 对肝病的有效性,以改善PC的交付.
主要方法:
- 在一个高等中心进行了为期6个月的QI项目,使用了三个数据周期 (基线和两个计划-做-研究-行动周期).
- PDSA 周期 1 涉及 SPICT 选,以触发 SPC 转介.
- 在PDSA Cycle 2中,使用SPICT查来促使肝病学和SPC团队之间的多学科会议.
主要成果:
- 在PDSA循环1中,显著减少了没有PC措施的患者 (67%至26%) 和增加了SPC输入 (32%至52%).
- 在PDSA循环1之后,社区PC转诊量显著增加,从13%增加到39%.
- 在PDSA循环2显示出有限的改善;只有42%的符合条件的患者在多学科会议上讨论,很少有计划包括SPC审查或高级护理规划.
结论:
- 尽管进行了干预措施,ESLD患者仍然存在未得到满足的PC需求.
- 在PDSA周期1中,SPICT证明了临床实用性,改善了ESLD患者的PC访问.
- 限制包括QI项目的小规模和单中心性质.
相关概念视频
Nursing Ethical Principles II
2.0K
Ethical principles are essential in guiding nurses to fulfill their responsibilities, focusing on the quality of nursing care and decision-making. These principles, including autonomy, beneficence, non-maleficence, justice, and fidelity, shape the ethical framework within healthcare settings.
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's...
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's...
2.0K
Continuing Care
1.8K
Continuing care describes the variety of health, personal, and social services provided over a prolonged period. The need for continuing care is increasing because people are living longer. Many people do not have families or others to care for them. Continuing care is mainly for patients who are disabled, functionally dependent, or suffering from a terminal disease. It is available within institutional settings or in homes. Examples include nursing centers or facilities, assisted living,...
1.8K
Chronic Pancreatitis II: Collaborative Care
282
The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
Assessment:
Assessment:
282
Esophageal Varices-II: Clinical Features and Management
334
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
334
Cardiomyopathy V: Interprofessional Care
305
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
305
Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
157
In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
157


