衛生福利部醫病共享決策平台
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決策輔助工具摘要表

當家人經過急救復甦後昏迷,為了提高清醒機率,我該使用「低溫療法」嗎? 最新更新日期:2020年01月07日
科別 內科,外科,神經內外科,其他
主題類別 7. 神經系統及感覺器官
決策類型 治療
關鍵字 低溫療法(therapeutic hypothermia),輕度誘導性低溫治療(mild induced hypothermia),到院前心跳停止(out hospital cardiac arrest),院內心跳停止(in hospital cardiac arrest)
適用病人條件 1. 所有到院前心跳停止經急救後回復自發性循環,意識仍不清者(GCS<8)或無遵循口頭醫囑(motor<6),且排除第三點所提及禁忌症之病人。 2. 所有院內心跳停止經急救後回復自發性循環,意識仍不清者(GCS<8)或無遵循口頭醫囑(motor<6),且排除第三點所提及禁忌症之病人。 3. 低溫治療禁忌症包括 a) 未控制的大量活動性出血狀況 b) 難治性休克 c) 嚴重感染症 d) 恢復自發性循環大於12小時 e) 腦出血 f) 收縮血壓<90mmHg或平均動脈壓<60mmHg g) 無法終止的致命性心律不整 h) 在心跳停止前即有失智或長期意識障礙或 i) 末期疾病患者。
可供選擇決策方案 重症觀護不合併低溫療法,接受重症觀護合併低溫療法
使用場所 病房、其他
執行者 醫師、護理師
開發團隊、機構 高雄榮民總醫院重症醫學部重症加護內科、教學研究部圖藝組、品質管理中心
團隊成員
版本
輔助工具研發過程說明 從死神手中將一條條寶貴生命搶救回來一直是所有醫護人員努力追求實踐的目標。然而在經過辛苦的奮鬥後,如何能在搶救回的生命中,確保戰果,將功能性的保存達到最大,一直是個醫療仍在繼續努力且未臻完美的課題。低溫療法由理論演進到可供臨床使用的工具不過幾年的光景,但它潛在的好處正由逐漸累積的證據一一證實,是這類患者及家屬的福音。筆者希望能經由對治療適應禁忌症的介紹,告知家屬優缺點及可能風險,讓所有可能因為低溫療法獲益的患者及家庭得到幫助。
為建置相關題材內容及決策輔助工具的雛形,本中心成立推動小組並設置行動專案,並邀請多職類人員組成團隊參與討論,當中包括重症加護內科、重症加護外科、心臟內科、急診醫學科、感染科、腎臟科、及胸腔內科等各專科醫師,專科護理師、護理師、及藥師等,且照護團隊亦由第一線的急診團隊,因應此治療所需特殊的一致連貫性,延伸至急性重症照護的加護病房團隊等團隊成員參與,希望能立足於實證醫學證據之上,提供連續的各環節評估以及完整的相關訊息,給予面對此重大決定的病人家屬決策的幫助,做出最合乎他們綜觀各面向考量的合適決策。
團隊成員經由實證醫學方法查閱篩檢相關文獻研究後,參酌由問卷方式取得病人家屬及相關從業各職類專業人員關於低溫療法的使用經驗,形成第一版文件。後以問卷方式進一步施行初版文件於病人家屬端及醫療專業人員端之alpha測試,後對內容予以修編,形成第二版本之文字輔助工具。惟對於此龐大繁瑣內容,經臨床使用考量評估後,擔憂專業術語文字解讀能力差異性,以及大量訊息所帶來的負載,對於做出最終決策所帶來的負面影響,故進一步邀集專業美編設計工作人員參與決策輔助工具之圖像化及量表化,形成圖像化後的第二版。爾後針對圖像後版本進一步施行beta測試,確認臨床適用性,形成圖像後文件第三版,冀求能’言雖簡但輔圖以達意’搭起醫病溝通的橋梁。
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醫病共享決策介紹
醫病共享決策(SDM)緣起
醫病共享決策輔助工具介紹
醫病共享決策實踐運動
醫病共享決策輔助工具競賽
醫病共享決策優化活動
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