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Implementation and evaluation of a network-based pilot program to improve palliative care in the intensive care unit.

Penrod JD, Luhrs CA, Livote EE, Cortez TB, Kwak J. Implementation and evaluation of a network-based pilot program to improve palliative care in the intensive care unit. Journal of pain and symptom management. 2011 Nov 1; 42(5):668-71.

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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.




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