Improving comfort and communication in the ICU: a practical new tool for palliative care performance measurement and feedback

Nelson, Judith E.; Mulkerin, Colleen; Adams, Laura L.; Pronovost, Peter J.

doi:10.1136/qshc.2005.017707

Cited by 177 publications

(157 citation statements)

References 41 publications

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“…Historically SICU physicians and nurses did not receive any formal education on how to Day 1 should include identification of appropriate decision maker, advance directive status, and cardiopulmonary resuscitation status, along with provision of an information leaflet. 12 The presence or absence of a surrogate decision maker should be documented in the first 24 hours. 13 The presence or absence of advance directives should be documented in the first 24 hours.…”

Section: Planning the Interventionmentioning

confidence: 99%

“…13 ICU day 3 bundle should include social work and spiritual support. 12 Pain that is assessed as greater than 3 on a 10-point scale should be treated, with reassessment after treatment. 13 Nursing and physician staff assigned to each patient are as consistent as possible.…”

Section: Planning the Interventionmentioning

confidence: 99%

“…18 ICU day 5 bundle should include interdisciplinary family meetings. 12 Formal scheduled family meetings involving multiple disciplines are an effective approach to talking with patients' families and encouraging dialogue about care. [19][20][21] Interdisciplinary family conference should occur within 72 hours of admission; documentation should include what was discussed.…”

Section: Planning the Interventionmentioning

confidence: 99%

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Improving Family Satisfaction and Participation in Decision Making in an Intensive Care Unit

Huffines

Johnson

Naranjo

et al. 2013

Critical Care Nurse

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Background Survey data revealed that families of patients in a surgical intensive care unit were not satisfied with their participation in decision making or with how well the multidisciplinary team worked together. Objectives To develop and implement an evidence-based communication algorithm and evaluate its effect in improving satisfaction among patients’ families. Methods A multidisciplinary team developed an algorithm that included bundles of communication interventions at 24, 72, and 96 hours after admission to the unit. The algorithm included clinical triggers, which if present escalated the algorithm. A pre-post design using process improvement methods was used to compare families’ satisfaction scores before and after implementation of the algorithm. Results Satisfaction scores for participation in decision making (45% vs 68%; z = −2.62, P = .009) and how well the health care team worked together (64% vs 83%; z = −2.10, P = .04) improved significantly after implementation. Conclusions Use of an evidence-based structured communication algorithm may be a way to improve satisfaction of families of intensive care patients with their participation in decision making and their perception of how well the unit’s team works together.

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Section: Planning the Interventionmentioning

confidence: 99%

Section: Planning the Interventionmentioning

confidence: 99%

Section: Planning the Interventionmentioning

confidence: 99%

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Improving Family Satisfaction and Participation in Decision Making in an Intensive Care Unit

Huffines

Johnson

Naranjo

et al. 2013

Critical Care Nurse

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“…For the analyses, we examined 2 types of pain management outcomes: 1) reduction in the average pain score, 20 defined as a decrease in the average pain score at 1 week after admission; and 2) achievement of adequate pain control, defined as an average pain score 3 at 1 week after admission. 21 …”

Section: Outcome Measuresmentioning

confidence: 99%

Variations in pain management outcomes among palliative care centers and the impact of organizational factors

Shin

Hwang

et al. 2012

Cancer

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BACKGROUND:The assessment of pain management outcomes is important for the quality assurance of palliative care. The objective of this study was to determine whether there are significant variations in pain management outcomes among palliative care centers and whether they are affected by organizational factors. METHODS: Data used in this investigation were from the 2009 Korean Terminal Cancer Patient Information System and administrative records of the 34 inpatient palliative care centers designated by the Korean Ministry of Health and Welfare in 2009. Self-reported pain scores (range, from 0 to 10) at admission and 1 week after admission were prospectively collected. Multilevel mixed-effect regression models were used to analyze the variations and the impact of organizational-level factors on 2 pain management outcomes (ie, reduction in average pain score and achievement of adequate pain control at 1 week after admission). RESULTS: In total, 1711 patients with terminal cancer were included in the analyses. The mean reduction in the pain score was 0.69 to 1.91 after 1 week, and most patients (82.8%) achieved adequate pain control. There were significant variations in pain management outcomes among palliative care centers. Higher composite scores for human resources adequacy were associated significantly with a greater reduction in pain score (b, 0.11; 95% confidence interval, 0.01-0.21), and achievement of adequate pain control (adjusted odds ratio, 1.26; 95% confidence interval, 1.10-1.45). CONCLUSIONS: There were significant variations in pain management outcomes among inpatient palliative care centers, and they were affected by organizational factors, such as human resources adequacy. Cancer 2012;118:5688-97.

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“…First, the nurse leaders guided the bedside nurse through the process of identifying the patient's uncontrolled signs and symptoms, 12 the family's support needs, 4,34 and communication to date about prognosis and goals of care. The rounds discussion included the bedside nurse's assessment of the family's and physicians' perspectives, and identifying whether a multidisciplinary family meeting had occurred.…”

Section: Specialty Palliative Nursing Coaching Roundsmentioning

confidence: 99%

Palliative Care Professional Development for Critical Care Nurses: A Multicenter Program

Anderson¹,

Puntillo²,

Cimino³

et al. 2017

Am J Crit Care

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Background Integrating palliative care into intensive care units (ICUs) requires involvement of bedside nurses, who report inadequate education in palliative care. Objective To implement and evaluate a palliative care professional development program for ICU bedside nurses. Methods From May 2013 to January 2015, palliative care advanced practice nurses and nurse educators in 5 academic medical centers completed a 3-day train-the-trainer program followed by 2 years of mentoring to implement the initiative. The program consisted of 8-hour communication workshops for bedside nurses and structured rounds in ICUs, where nurse leaders coached bedside nurses in identifying and addressing palliative care needs. Primary outcomes were nurses' ratings of their palliative care communication skills in surveys, and nurses' identification of palliative care needs during coaching rounds. Results Each center held at least 6 workshops, training 428 bedside nurses. Nurses rated their skill level higher after the workshop for 15 tasks (eg, responding to family distress, ensuring families understand information in family meetings, all P < .01 vs preworkshop). Coaching rounds in each ICU took a mean of 3 hours per month. For 82% of 1110 patients discussed in rounds, bedside nurses identified palliative care needs and created plans to address them. Conclusions Communication skills training workshops increased nurses' ratings of their palliative care communication skills. Coaching rounds supported nurses in identifying and addressing palliative care needs. (American Journal of Critical Care. 2017; 26:361-371) by AACN on May 12, 2018 http://ajcc.aacnjournals.org/ Downloaded from P alliative care is a specialty and focus of care that aims to improve quality of care for patients who have serious and complex illnesses and their families. [1][2][3] Patients in intensive care units (ICUs) and their families have palliative care needs, including emotional support, management of pain and symptoms, and clinician-family communication to ensure that patients receive treatments that are consistent with their goals. [3][4][5][6][7][8][9][10][11][12][13] AJCC AMERICAN JOURNAL OF CRITICAL CARE, September 2017, Volume 26, No. 5 www.ajcconline.orgIn the ICU, palliative care is provided along with life-sustaining therapies and may be delivered by the ICU team (primary palliative care), a palliative care consult service (specialty palliative care), or both. 2,3,14 A number of barriers to integrating palliative care into the ICU have been identified, including inadequate training of clinicians and misperceptions that such treatment is the same as hospice, comfortfocused care, or end-of-life care. 3 Families, physicians, and nurses identify involvement of bedside nurses as a key factor in the quality of ICU palliative care. [15][16][17][18][19][20] Nurses' training and constancy at the bedside position them to identify palliative care needs, coordinate communication among families and an array of clinicians, and support and educate families. 15,16,19...

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Improving comfort and communication in the ICU: a practical new tool for palliative care performance measurement and feedback

Cited by 177 publications

References 41 publications

Improving Family Satisfaction and Participation in Decision Making in an Intensive Care Unit

Improving Family Satisfaction and Participation in Decision Making in an Intensive Care Unit

Variations in pain management outcomes among palliative care centers and the impact of organizational factors

Palliative Care Professional Development for Critical Care Nurses: A Multicenter Program

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