内容紹介
Summary
The majority of patients with in-home palliative care desire to remain at home through their end of life. However, symptomatic crises, unless promptly controlled, can cause unwanted hospital admissions. In the past 2 decades, it has become common to place a package of several medications in the patient's home for family caregivers to use to treat symptoms when the oral route is lost. These emergency medication kits(EMK)are capable of addressing the common symptoms that arise at end of life, such as pain, dyspnea, delirium, and retained respiratory secretions. The EMK are for the patient or family caregivers to use at the direction of their home hospice nurse or physician. Medications in the EMK are selected for their versatility in potentially addressing multiple symptoms, and their ability to be administered buccally, sublingually, or transdermally, simplifying administration by family caregivers. The EMK facilitate timely symptom control, allowing families to avoid emergency department visits, unscheduled nursing visits, and usually result in cost savings. Additionally, family caregivers feel empowered by its presence in their home and its contribution to patient, family caregiver and nurse satisfaction. To date in Japan, the literature related to the use and impact of EMKs is sparse. Further investigation is needed into the use, clinical efficacy, and impact of the EMK.
要旨
自宅で最期まで穏やかに過ごすためには,予測される症状に対する適切な薬物選択と,内服が困難となった際に家族・介護者でも実施可能な投与経路の選択が必要となる。在宅コンフォートセット(以下,セット)は,痛み,呼吸困難,せん妄,気道分泌過多など看取りの時期に生じる苦痛に対する臨時投与薬であり,在宅療養の継続を目的として患家への設置が普及している。セットの導入により迅速な症状緩和が可能となり,救急外来への受診や緊急入院の防止,家族・介護者の不安・負担の軽減,医療スタッフの臨時訪問に伴う経費の削減,訪問看護師のストレスの緩和など多くの効果が報告されている。選択される薬剤は,1剤で複数の症状に対して効能が発揮されるものが多く,家族・介護者が投与する場合に備えて剤型は液剤(舌下),坐剤などである。わが国においてはセットに関する報告は少なく,最期まで自宅で過ごすという患者本人と家族の願いを叶えていくためにも,セット導入の実態調査とその有効性の検証,課題解決への取り組みが必要である。
目次
The majority of patients with in-home palliative care desire to remain at home through their end of life. However, symptomatic crises, unless promptly controlled, can cause unwanted hospital admissions. In the past 2 decades, it has become common to place a package of several medications in the patient's home for family caregivers to use to treat symptoms when the oral route is lost. These emergency medication kits(EMK)are capable of addressing the common symptoms that arise at end of life, such as pain, dyspnea, delirium, and retained respiratory secretions. The EMK are for the patient or family caregivers to use at the direction of their home hospice nurse or physician. Medications in the EMK are selected for their versatility in potentially addressing multiple symptoms, and their ability to be administered buccally, sublingually, or transdermally, simplifying administration by family caregivers. The EMK facilitate timely symptom control, allowing families to avoid emergency department visits, unscheduled nursing visits, and usually result in cost savings. Additionally, family caregivers feel empowered by its presence in their home and its contribution to patient, family caregiver and nurse satisfaction. To date in Japan, the literature related to the use and impact of EMKs is sparse. Further investigation is needed into the use, clinical efficacy, and impact of the EMK.
要旨
自宅で最期まで穏やかに過ごすためには,予測される症状に対する適切な薬物選択と,内服が困難となった際に家族・介護者でも実施可能な投与経路の選択が必要となる。在宅コンフォートセット(以下,セット)は,痛み,呼吸困難,せん妄,気道分泌過多など看取りの時期に生じる苦痛に対する臨時投与薬であり,在宅療養の継続を目的として患家への設置が普及している。セットの導入により迅速な症状緩和が可能となり,救急外来への受診や緊急入院の防止,家族・介護者の不安・負担の軽減,医療スタッフの臨時訪問に伴う経費の削減,訪問看護師のストレスの緩和など多くの効果が報告されている。選択される薬剤は,1剤で複数の症状に対して効能が発揮されるものが多く,家族・介護者が投与する場合に備えて剤型は液剤(舌下),坐剤などである。わが国においてはセットに関する報告は少なく,最期まで自宅で過ごすという患者本人と家族の願いを叶えていくためにも,セット導入の実態調査とその有効性の検証,課題解決への取り組みが必要である。