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首页> 外文期刊>Journal of the advanced practitioner in oncology >Palliative Integration Into Ambulatory Oncology: An Advance Care Planning Quality Improvement Project
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Palliative Integration Into Ambulatory Oncology: An Advance Care Planning Quality Improvement Project

机译：池灰体融入动态肿瘤：一个先进的护理计划质量改进项目

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Advance care planning (ACP) is essential to ensuring that patient-centered end-of-life goals are respected if a health crisis occurs. Advanced practitioner barriers to ACP include insufficient time and limited confidence in discussions. The purpose of this quality improvement project was to increase advanced cancer patients' electronic health record (EHR) documented surrogate decision maker and ACP documentation by 25% over 8 weeks. A secondary aim was to decrease patients' decisional conflict scores (DCS) related to life-sustaining treatment preferences after a clinical nurse specialist (CNS)-led ACP session. Using the define, measure, analyze, improve, and control (DMAIC) process of quality improvement methodology, an interprofessional team led by a palliative CNS fostered practice change by (a) incorporating a patient self-administered Supportive Care and Communication Questionnaire (SCCQ) to standardize the ACP assessment, (b) creating an EHR nursing and provider documentation template, (c) offering advanced cancer patients a palliative CNS consultation for ACP review and advance directive completion, and (d) evaluating patients' DCS through the four-item SURE tool. Of 126 participants provided with the SCCQ, 90 completed the document, resulting in a 71% return rate. Among the completed SCCQs, 37% (n = 33) requested a CNS consultation, with 76% (n = 25) returning for the ACP session. The CNS intervention yielded an average reduction of 1.4 points in SURE tool findings, a statistically significant decrease determined by a paired sample t-test. The project's interprofessional collaboration promoted a system-wide standardized ACP process throughout ambulatory, acute, and post-hospital settings.
机译：提前护理计划（ACP）对于确保在发生健康危机时尊重以患者为中心的临终目标至关重要。高级从业者对ACP的障碍包括时间不足和对讨论的信心有限。该质量改进项目的目的是在8周内将晚期癌症患者的电子健康记录（EHR）记录的替代决策者和ACP记录增加25%。第二个目的是在临床护理专家（CNS）领导的ACP治疗后，降低患者与维持生命治疗偏好相关的决策冲突评分（DC）。使用质量改进方法的定义、测量、分析、改进和控制（DMAIC）过程，由姑息性中枢神经系统（CNS）促进的跨专业团队通过（a）合并患者自我管理的支持性护理和沟通问卷（SCCQ）来规范ACP评估，（b）创建EHR护理和提供者文档模板，（c）为晚期癌症患者提供姑息性CNS咨询，以进行ACP审查和提前完成指令，以及（d）通过四项SURE工具评估患者的DC。在提供SCCQ的126名参与者中，有90人完成了该文件，获得了71%的回报率。在完成的SCCQ中，37%（n=33）要求进行CNS咨询，76%（n=25）返回ACP会议。CNS干预使SURE工具的结果平均减少1.4个点，通过配对样本t检验确定，这在统计学上是显著的减少。该项目的跨专业合作促进了整个门诊、急症室和院后环境的全系统标准化ACP流程。

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