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

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; o...

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Bibliographic Details
Published in:Journal of pain and symptom management 2011-11, Vol.42 (5), p.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: Article
Language:English
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
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Summary: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.
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2011.06.012