To establish an indigenous model 0f taiwan hospice palliative care
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To Establish an Indigenous Model 0f Taiwan Hospice Palliative Care. 台北醫學大學附設醫院 腫瘤中心 邱仲峰主任. 「安寧療護 」定義 ( WHO ‧‧1990 ) ( 一). 對治癒性治療無反應及利益的末期病患之 整體積極 的照顧。此時給予病人疼痛控制及其他症狀的緩解,再加心理層面、社會層面及靈性層面之照顧更為重要 。. 「安寧療護 」定義 ( WHO ‧‧ 1990 ) ( 二).

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To establish an indigenous model 0f taiwan hospice palliative care

To Establish an Indigenous Model 0f Taiwan Hospice Palliative Care

台北醫學大學附設醫院

腫瘤中心

邱仲峰主任


「安寧療護 」定義

(WHO‧‧1990) (一)

對治癒性治療無反應及利益的末期病患之整體積極的照顧。此時給予病人疼痛控制及其他症狀的緩解,再加心理層面、社會層面及靈性層面之照顧更為重要。


「安寧療護 」定義 (WHO‧‧1990) (二)

安寧療護的目標是協助病患及其家屬獲得最佳的生活品質。安寧療護的某些方式甚至在病患罹病的早期也可適用。例如抗癌治療與症狀緩解治療同時進行。

--1999.趙--


Hospice

Palliative

安寧

緩和

安 寧 緩 和



Death

Diagnosis

Hospice

Palliative

Care

Anti-Cancer

Treatment


Death

Diagnosis

Curative Treatment

Bereavement

Hospice

Palliative Care


Death

Diagnosis

Curative Treatment

Bereavement

Hospice

Palliative Care


2000 Walsh

Sheffield Model

Bereavement

Curative

Anticancer Therapies

Life-prolonging

Terminal

Supportive Therapies

Palliative care * Rehabilitation * S W * Spiritual


Taiwan

Hospice Palliative Care

goes

main stream


安寧緩和醫療服務的對象

患有嚴重漸進性疾病的病人

(People with advanced progressive

disease)


安寧

緩和

秋葉 夕陽 落葉

林間夏蟬絕唱

擁抱生命最後的光輝

不再作什麼積極的治療,只有….


‧‧贏

勇敢無懼

積極‧‧主動‧‧陽光

面對生命的病痛苦難


一步一腳印

  • 安寧緩和醫療專業人員課程標準

  • 安寧緩和醫療健保給付制度(試辦)

  • 安寧緩和醫療條例

  • 安寧緩和醫療品質保證計劃(評鑑)

  • 台灣安寧緩和醫學專科醫師制度




Insurance Coverage

Daily Living Support

Medical

(Physical)Care

Psychosocial

Care

Spiritual

care

National Insurance Coverage


安寧緩和醫療條例

中華民國八十九年六月七日

華總一義字第八九零零一三五零八零號令公布

(1)預立選擇安寧緩和醫療意願書

(2)選擇安寧緩和醫療意願書

(3)預立不施行心肺復甦術意願書

(4)不施行心肺復甦術意願書

(5)不施行心肺復甦術同意書

(6)預立醫療委任代理人委任書


  • 第一條

  • 為尊重不可治癒末期病人之醫療意願及保障其權益,特制定本條例;本條例未規定者,適用其他有關法律之規定。

  • 第二條

  • 本條例所稱主管機關:在中央為行政院衛生署;在直轄市為直轄市政府;在縣(市)為縣(市)政府。

  • 第三條

  • 本條例專用名詞定義如下:

  • 安寧緩和醫療:指為減輕或免除末期病人之痛苦,施予緩解性、支持性之安寧醫療照護,或不施行心肺復甦術。

  • 末期病人:指罹患嚴重傷病,經醫師診斷認為不可治癒,且有醫學上之證據近期內病程進行至死亡已不可避免者。

  • 心肺復甦術:指對臨終或無生命徵象之病人,施予氣管內插管、體外心臟按壓、急救藥物注射、心臟電擊、心臟人工調頻、人工呼吸或其他救治行為。

  • 意願人:指立意願書選擇安寧緩和醫療全部或一部之人。


總 統 令

  • 華總一義字第零九一零零二三九零二零號

茲修正安寧緩和醫療條例第三條及第七條

條文,公佈之. (中華民國九十一年十二月十一日)

---------末期病人符合第一項,

第二項規定不施行心肺復甦術

之情形時,原施予之心肺復甦術

,得予終止或撤除.


1999 4
安寧療護服務量比較表(1999.4月)

1999.安寧基金會.賴

1999.21世紀安寧研討會.羅

1998.衛生署.陳


Contracted hospital
Contracted Hospital

  • Object - promotion of new hospice

    units No. of Hospital - 49

  • Contract renewal - every year

    Available hospice units - 22

    Potential hospice units - 27



Coverage Ratio(1)

:2.65%

Coverage Ratio(2)

:5.7%(1997,羅)

安寧療護是高品質的醫療!

安寧療護是高貴的醫療?!

(APHC 1999. Hong Kong)


  • Service Utility 2002

  • (unpublished datae)

  • In Patient Beds : 56.22%

  • Home Care : 2315 PT

  • Day Care : 0 Unit

  • Out Patient Clinic : *136 U/week

  • *resources: DOH, mixed type



轉介安寧病房5日內死亡

﹝安寧療護服務品質稽核及作業系統之建立--衛署87、88﹞

20.41%


Quality of assurance accreditation
Quality of Assurance Accreditation

  • Since 2000

  • Balance between quantity and quality

  • Pilot Project of Bureau of National Health Insurance

  • Monitored by TAHPM

  • Supervised by Department of Health


Quality of assurance input hospice in patient unit 14 items assessment
Quality of Assurance : input(hospice in-patient unit: 14 items assessment)

  • service philosophy

  • organization structure

  • continuity of care

  • clinical management

  • manpower

  • qualification of team specialty

  • environment

  • facility

  • teamwork

  • family support

  • audit

  • symptom control

  • education and training

  • communication

documents assessment

visits assessment

visits assistance


Quality of assurance input hospice home care unit 13 items assessment
Quality of Assurance : input(hospice home care Unit: 13 items assessment)

  • service philosophy

  • organization structure

  • continuity of care

  • clinical management

  • manpower

  • qualification of team specialty

  • safety and equipments

  • teamwork

  • family support

  • audit

  • symptom control

  • education and training

  • communication

documents assessment

visits assessment

visits assistance



Quality of Assurance : output

 2001 

Home Care unit

Rank A: 14

Rank B: 8

Rank C: 3

Rank D: 5

In-patient unit

Rank A: 7

Rank B: 7

Rank C: 6

Rank D: 6


Indigenous Palliative Care

日間療護

居家療護

AMOEBA

病房療護


外展模式 的安寧緩和醫療

Making Pain Control & Palliative Care

a

Health Priority


TAIWAN ACADEMY HOSPICE PALLIATIVE MEDICINE

I.D.

Specialist of Hospice Palliative Medicine



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