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

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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


To establish an indigenous model 0f taiwan hospice palliative care

「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。


To establish an indigenous model 0f taiwan hospice palliative care

「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--


To establish an indigenous model 0f taiwan hospice palliative care

Hospice

Palliative

安寧

緩和

安 寧 緩 和


To establish an indigenous model 0f taiwan hospice palliative care

  • 四全照護

    • 全人

  • 全隊

  • 全家

  • 全程

  • 趙可式


To establish an indigenous model 0f taiwan hospice palliative care

Death

Diagnosis

Hospice

Palliative

Care

Anti-Cancer

Treatment


To establish an indigenous model 0f taiwan hospice palliative care

Death

Diagnosis

Curative Treatment

Bereavement

Hospice

Palliative Care


To establish an indigenous model 0f taiwan hospice palliative care

Death

Diagnosis

Curative Treatment

Bereavement

Hospice

Palliative Care


To establish an indigenous model 0f taiwan hospice palliative care

2000 Walsh

Sheffield Model

Bereavement

Curative

Anticancer Therapies

Life-prolonging

Terminal

Supportive Therapies

Palliative care * Rehabilitation * S W * Spiritual


To establish an indigenous model 0f taiwan hospice palliative care

Taiwan

Hospice Palliative Care

goes

main stream


To establish an indigenous model 0f taiwan hospice palliative care

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)


To establish an indigenous model 0f taiwan hospice palliative care

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….


To establish an indigenous model 0f taiwan hospice palliative care

拼‧‧贏

勇敢無懼

積極‧‧主動‧‧陽光

面對生命的病痛苦難


To establish an indigenous model 0f taiwan hospice palliative care

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


To establish an indigenous model 0f taiwan hospice palliative care

安寧療護專業人員標準課程架構


To establish an indigenous model 0f taiwan hospice palliative care

安寧療護專業人員標準課程架構


To establish an indigenous model 0f taiwan hospice palliative care

Insurance Coverage

Daily Living Support

Medical

(Physical)Care

Psychosocial

Care

Spiritual

care

National Insurance Coverage


To establish an indigenous model 0f taiwan hospice palliative care

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


To establish an indigenous model 0f taiwan hospice palliative care

  • 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。


To establish an indigenous model 0f taiwan hospice palliative care

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


To establish an indigenous model 0f taiwan hospice palliative care

台灣安寧療護發展史


To establish an indigenous model 0f taiwan hospice palliative care

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)


To establish an indigenous model 0f taiwan hospice palliative care

  • 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


To establish an indigenous model 0f taiwan hospice palliative care

羊在廄外


To establish an indigenous model 0f taiwan hospice palliative care

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

Quality of Assurance : output


To establish an indigenous model 0f taiwan hospice palliative care

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


To establish an indigenous model 0f taiwan hospice palliative care

Indigenous Palliative Care

日間療護

居家療護

AMOEBA

病房療護


To establish an indigenous model 0f taiwan hospice palliative care

外展模式的安寧緩和醫療

Making Pain Control & Palliative Care

a

Health Priority


To establish an indigenous model 0f taiwan hospice palliative care

TAIWAN ACADEMY HOSPICE PALLIATIVE MEDICINE

I.D.

Specialist of Hospice Palliative Medicine


To establish an indigenous model 0f taiwan hospice palliative care

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