Bringing Palliative Care to the MICU: A Team Approach (QI731)

• Published in: Journal of pain and symptom management Vol. 61; no. 3; pp. 668 - 669
• Main Authors: Pelissier, Latrice, Pan, Cynthia, Abe, Olumayowa, Kurian, Seema, Yea, Stephanie, Qu, Lucy, Cotter, Elizabeth, Ledlie, Susan
• Format: Journal Article
• Language: English
• Published: Madison Elsevier Inc 01.03.2021; Elsevier Limited
• Subjects: Communication skills; Competence; Documentation; Educational programs; Email; End of life decisions; Hospice care; Intensive care; Interdisciplinary aspects; Intervention; Palliative care; Quality management; Queens; Role playing; Teams; Vignettes
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2021.01.063

Objectives 1. Describe the evidenced-based trigger list and documentation bundle that was newly created for this QI project. 2. Describe the available resources to help communicated with patients who are seriously ill. 3. Verbalize that a standardized approach to identify patients with unmet PC needs helps increase goals of care discussions and palliative care consult. Background Research suggests that unmet palliative care (PC) needs of MICU patients may be attributed to a lack of PC education and self-perceived competency among professional MICU staff. Aim Statement The aims of this quality improvement project included: (*) Examining the effect of an NP-directed educational intervention on increasing self-perceived competency of end of life care among professional staff in the MICU. (*) Developing a standardized, interdisciplinary process that identifies patients with unmet palliative care needs. (*) Examining the impact of a standardized intervention on utilization of the trigger list and documentation bundle, to increase PC consults, and GOCDs. Methods Forty participants from the professional MICU staff of a Queens, New York hospital completed the 28-item Self-Perceived Competency in End of Life Care (EOL-ICU) questionnaire via email. The staff attended an educational session which consisted of a didactic lecture covering PC principles, reviewing newly developed documents intended to increase the number of PC consults, and goals of care discussions (GOCD), watching video vignettes which focused on enhancing communication skills, and engaging in active role play exercises. Four weeks post-intervention, the EOL-ICU was emailed to participants to assess perceived self- competency. Results Post-test EOL-ICU scores revealed a 12-point increase in self-perceived competencies. In addition, three months post-intervention, 58% of patients triggered a PC intervention and there was a 16% increase in PC consults. Lastly, charts were reviewed indicating change favorable change in documentation compliance. Conclusions and Implications The professional MICU staff utilized the new trigger list and documentation bundle. This led to an increase in PC consults and GOCDs. These findings indicate that this intervention was successful. By adopting a standardized approach, the professional MICU staff had the increased ability to identify patients with unmet PC needs.