Implementation and Evaluation of a Network-Based Pilot Program to Improve Palliative Care in the Intensive Care Unit

• Published in: Journal of pain and symptom management Vol. 42; no. 5; pp. 668 - 671
• Main Authors: Penrod, Joan D., PhD, Luhrs, Carol A., MD, Livote, Elayne E., MPH, MS, MA, Cortez, Therese B., MSN, NP, ACHPN, Kwak, Jennifer, BA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2011
• Subjects: Aged; Anesthesia & Perioperative Care; critical care; Decision makers; Female; Humans; ICU; Intensive care; intensive care unit; Intensive care units; Intensive Care Units - organization & administration; Intensive Care Units - standards; Intensive Care Units - trends; Length of Stay; Male; Outcome Assessment (Health Care); Pain Medicine; Palliative care; Palliative Care - organization & administration; Palliative Care - standards; Palliative Care - trends; Pilot Projects; Quality Improvement; Referral and Consultation - organization & administration; Referral and Consultation - standards; Referral and Consultation - trends; Social work; Socioeconomic Factors; Teams; United States; United States Department of Veterans Affairs; United States; United States > US; Palliative care; critical care; intensive care unit; ICU; quality improvement
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2011.06.012

Abstract Background Intensive care unit (ICU) care could be improved by implementation of time-triggered evidence-based interventions including identification of a patient/family medical decision maker, the patient’s advance directive status, and cardiopulmonary resuscitation preferences by Day 1; offer of social work and spiritual support by Day 3; and a family meeting establishing goals of care by Day 5. We implemented a program to improve care for ICU patients in five Department of Veterans Affairs’ ICUs. Measures We measured the percent of ICU patients with lengths of stay of five or more days that received the care processes by the appropriate day. Intervention Critical care and palliative care providers trained ICU nurse teams to improve care through auditing, performance feedback, improvement tools, education, and monthly team meetings. Outcomes Pre- and postintervention care were compared. Offering social work and spiritual support, identification of the medical decision maker, and documentation of family meetings significantly improved. Conclusions/Lessons Learned ICU nurse teams can be engaged to improve care under the aegis of a collaborative quality improvement project.