Practice and Documentation of Palliative Sedation: A Quality Improvement Initiative

Abstract

ConclusionsThe lack of documentation and standardized practice of ps on our pcu has resulted in a quality improvement program to address those gaps. They also highlight the importance of conducting research and developing clinical guidelines in this area. KEY WORDSPalliative care, conscious sedation, deep sedation, documentation, hypnotics and sedatives BACKGROUNDPalliative sedation (ps) is the intentional, continuous use of sedative medications with the goal of reducing consciousness and relieving intolerable suffering from refractory symptoms in patients who are at end of life (that is, last hours to days) 1 . A symptom is considered refractory when all possible treatments available within a tolerable time frame and risk-benefit ratio have been tried, but have not been successful 1 . Throughout the literature, the frequency of ps ranges from 2% to 52% depending on setting, research methodology, and definition 2 . Studies show that, when appropriately administered, ps does not invariably hasten death 3 . It is an essential therapy that is ethically justifiable when used appropriately with the intention of relieving intolerable suffering and not shortening life [4][5][6] . Common indications for ps include intractable delirium, dyspnea, seizures, and severe pain 2,7 . Controversial indications that have to be evaluated on an individual basis include sedation for psychological or existential suffering 3,8 . Midazolam, administered by continuous infusion, is the drug of choice for ps 1,2,7 . Other medications include methotrimeprazine and phenobarbital 2,9 .Over the last several years, ps has appropriately received increasing attention, and national and international guidelines have been developed to guide ABSTRACT Background

Palliative Sedation—Still a Complex Clinical Issue!

“…The review concluded that there is an urgent need "to resolve the conceptual confusion that currently exists in the literature." That comment by the authors about the possibility that terminology confusion is, in the end, a reflection of confusion in clinical practice resonates very well with the quality improvement report by McKinnon et al 1 .…”

“…In view of increasing interest in that topic and some of the surrounding controversy, the presentation in this issue of Current Oncology of a quality improvement report by McKinnon et al 1 on the use and documentation of the practice in their palliative care setting is timely and arguably a wake-up call to other programs. Those authors identified a number of documentation deficits and the need to implement guidelines that standardize charting and staff education.…”

In-service documentation tools and statements on palliative sedation in Germany—do they meet the EAPC framework recommendations? A qualitative document analysis

“…Large variations in PS practice are found and, as a result, clinical performance still differs (24,25). Additionally, a lack of documentation and standardized practice of PS was apparent in an audit of PS practice performed as a quality improvement program (25).…”

“…Additionally, a lack of documentation and standardized practice of PS was apparent in an audit of PS practice performed as a quality improvement program (25).…”

Multi-Professional Medical Record on Continuous Palliative Sedation in an Inpatient Hospice: A Feasibility Pilot Study

“…Monitoring all aspects of CPS is essential and widely recommended. 2,11,26,[30][31][32] Before the start of our study we analyzed the data about the different aspects of the CPS documented in the clinical diary of the patients who died in Bentivoglio Hospice. The Bentivoglio Hospice belongs to the Hospice Seràgnoli Foundation Onlus, an operational structure coordinated by the Isabella Seràgnoli Foundation, Bologna (Italy).…”