The impact of a universal inpatient palliative care consultation protocol for patients with gynecologic cancer: a quality improvement project

Background: A critical aspect of pediatric palliative care consultations is the assessment and documentation of patient and family needs. While these assessments usually include a focus on physical pain, there is less standardization of assessments of other physical symptoms and psychosocial, emotional, or spiritual needs. Aims: To improve the breadth of assessment of psychosocial and emotional needs, screen for symptoms other than pain among pediatric patients utilizing palliative care services, and to increase documentation of assessment data from 30%-40% to 80% through practice changes implemented in 2 Plan-Do-Study-Act (PDSA) cycles. Methods: This quality improvement project involved implementing provider education and adapting the palliative care consultation template in the electronic health record to improve breadth and consistency of assessment and documentation during consultations by the interdisciplinary pediatric palliative care team. Two PDSA cycles were performed. Chi squared tests and statistical control charts were used for data analysis. Results: There was statistically significant improvement in the inclusion of documentation of a pediatric palliative care social work note from baseline (32%) to Cycle 2 (57%). Physical symptom screening declined slightly, but not significantly (p = .32) and socio-emotional discussions also declined but not significantly (p = .05). Conclusions: Screening for physical symptoms and discussions with patients and families about psychosocial/emotional needs during the initial palliative care consultations are extremely important in providing effective, holistic, patient-centered care. There is a need for development of pediatric-centric guidelines and quality measures to evaluate pediatric palliative care programs; further research is indicated to determine methods for evaluating compliance with these guidelines.

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Feasibility of Implementing a Standard Operating Protocol for Safe Opioid Prescribing in Outpatient Palliative Care: A Quality Improvement Project (F425A)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2021.01.033 ◽

2021 ◽

Vol 61 (3) ◽

pp. 652

Author(s):

Margaret R. Bauer ◽

Tracy L. Shamas ◽

Sarah Gillespie-Heyman ◽

Samuel Adelman ◽

Andrea Ruskin

Keyword(s):

Palliative Care ◽

Quality Improvement ◽

Quality Improvement Project ◽

Improvement Project ◽

Opioid Prescribing ◽

Standard Operating ◽

Safe Opioid Prescribing ◽

Standard Operating Protocol

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Early Palliative Care Consultation in the Burn Unit: A Quality Improvement Initiative to Increase Utilization

Journal of Burn Care & Research ◽

10.1093/jbcr/irab140 ◽

2021 ◽

Author(s):

Heather Carmichael ◽

Hareklia Brackett ◽

Maurice C Scott ◽

Margaret M Dines ◽

Sarah E Mather ◽

...

Keyword(s):

Palliative Care ◽

Small Sample ◽

Quality Improvement Initiative ◽

Comfort Care ◽

Early Palliative Care ◽

Palliative Care Consultation ◽

Before And After ◽

Care Consultation ◽

Patient Values ◽

The Impact

Abstract Despite significant morbidity and mortality for major burns, palliative care consultation (PCC) is underutilized in this population. The purpose of this study is to examine the impact of a protocol using recommended “triggers” for PCC at a single academic burn center. This is a retrospective review of patient deaths over a four-year period. Use of life-sustaining treatments, comfort care (de-escalation of one or more life-sustaining treatments) and do not attempt resuscitation (DNAR) orders were determined. Use of PCC was compared during periods before and after a protocol establishing recommended triggers for early (<72 hrs of admission) PCC was instituted in 2019. A total of 33 patient deaths were reviewed. Most patients were male (n=28, 85%) and median age was 62 years [IQR 42-72]. Median revised Baux score was 112 [IQR 81-133]. Many patients had life-sustaining interventions such as intubation, dialysis, or cardiopulmonary resuscitation, often prior to admission. Amongst patients who survived >24 hrs, 67% (n=14/21) had PCC. Frequency of PCC increased after protocol development, with 100% vs. 36% of these patients having PCC before death (p=0.004). However, even during the later period, less than half of patients had early PCC despite meeting criteria at admission. In conclusion, initiation of life-sustaining measures in severely injured burn patients occurs prior to or early during hospitalization. Thus, value-based early goals of care discussions are valuable to prevent interventions that do not align with patient values and assist with de-escalation of life-sustaining treatment. In this small sample, we found that while there was increasing use of PCC overall after developing a protocol of recommended triggers for consultation, many patients who met criteria at admission did not receive early PCC. Further research is needed to elucidate reasons why providers may be resistant to PCC.

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Integration of Early Palliative Care in Oncology Patients: Improving Nursing Knowledge and Confidence

10.28971/532019hj118 ◽

2019 ◽

Author(s):

Jacqueline Hurteau

Keyword(s):

Palliative Care ◽

Quality Improvement ◽

Nursing Education ◽

Program Development ◽

Quality Improvement Project ◽

Improvement Project ◽

Early Palliative Care ◽

Early Implementation ◽

Oncology Care ◽

Nurses Knowledge

Palliative care integrated with standard oncology care in cancer patients has been shown to provide a number of beneficial clinical outcomes. Despite the evidence, the utilization of palliative care in the oncology population continues to be inadequate. The purpose of this program development, quality improvement project was to improve nurses’ knowledge regarding palliative care and the benefits of its early implementation in the oncology population, as well as to improve their confidence regarding palliative care consultations to providers. An educational intervention was designed and a pre and posttest were utilized to determine the effect of the intervention. This program development, quality improvement project demonstrated that the implementation of nursing education regarding palliative care within the oncology population increased nurses’ knowledge in palliative care, specific to the oncology population, as well as confidence in recommending appropriate palliative care consultations to providers.

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0707 “What We’Ve Got Here Is Failure To Communicate”: Apnea Patients And Their DME Suppliers

SLEEP ◽

10.1093/sleep/zsaa056.703 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A269-A269

Author(s):

S Thapa ◽

S Agrawal ◽

M Kryger

Keyword(s):

Quality Improvement ◽

Sleep Apnea ◽

Quality Improvement Project ◽

Timely Manner ◽

Improvement Project ◽

Therapy Initiation ◽

Obstructive Sleep ◽

Key Factor ◽

The Impact ◽

The Relationship

Abstract Introduction Successful treatment of obstructive sleep apnea requires adherence to positive airway pressure (PAP) therapy. A key factor is the relationship between the DME provider and the patient so that treatment can be initiated and continued in a timely manner. Our quality improvement project aims to empower and enable patients towards active participation in their sleep apnea care. Our goal is to ultimately increase patients’ knowledge of their Durable Medical Equipment (DME) supplies company, and thus improve their treatment. The first step was to determine patients’ familiarity with their DME. Methods Forty-one patients with sleep apnea on PAP therapy volunteered to be questioned about their DME company during clinic visits at the Yale North Haven Sleep Center, Connecticut, starting November 2019. Patients were asked if they knew the name or the contact of their DME; whether they received adequate training on PAP therapy initiation; if they were receiving timely and correct PAP therapy supplies. They were asked to rate their satisfaction with the DME on a scale of 1 to 5; one being very dissatisfied and five being very satisfied. Results Only 12 out of 41 patients (29.3 percent) knew the names of their DME companies. The average satisfaction rating was 3 (neutral); 44% of patients were dissatisfied, or very dissatisfied with the performance of their DME. Detailed comments were mostly related to poor contact and communication with the DME. Conclusion Most apnea patients had difficulty identifying and contacting their DME. As the next step of this quality improvement project we plan to intervene to ensure that the patients have the name and contact information of their DME available and attached to their PAP machine equipment. We plan to repeat this questionnaire after this intervention to study the impact of this quality improvement project. Support None

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Approach to Palliative Care Consultation for Patients With Malignant Bowel Obstruction in Gynecologic Oncology: A Qualitative Analysis of Physician Perspectives

JCO Oncology Practice ◽

10.1200/jop.19.00710 ◽

2020 ◽

Vol 16 (8) ◽

pp. 483-489

Author(s):

Claire Hoppenot ◽

Fay J. Hlubocky ◽

Julie Chor ◽

S. Diane Yamada ◽

Nita K. Lee

Keyword(s):

Palliative Care ◽

Qualitative Analysis ◽

Bowel Obstruction ◽

Gynecologic Oncology ◽

Gynecologic Cancer ◽

Malignant Bowel Obstruction ◽

Specific Patient ◽

Palliative Care Consultation ◽

Care Consultation ◽

Nonsurgical Patients

PURPOSE: Malignant bowel obstruction (MBO) from gynecologic cancer is associated with increased symptoms and short survival. A gynecologic oncologist’s approach to palliative care consultation in the setting of MBO has not been well studied—it could be an opportune time for collaboration with palliative care. MATERIALS AND METHODS: This qualitative analysis of interviews with gynecologic oncologists focuses on their perspectives on palliative care consultation at the time of MBO. Interviews were analyzed using a framework analysis, and key themes and quotations were extracted. RESULTS: We interviewed 15 gynecologic oncologists from 8 institutions in Chicago. They described a variety of expectations from palliative care consultation. Most frequently, they consulted palliative care for specific questions but managed the remainder of the care. Most participants frequently consulted palliative care, but they also worried about fragmentation of care, the timing of when to introduce a new team during MBO, and the selection of appropriate patients for a limited resource. Many participants preferred earlier palliative care consultation, and many described an emotional toll of caring for patients with MBO. Palliative care consultation was most readily discussed for nonsurgical patients. CONCLUSION: Participants’ expectations of palliative care consultations during MBO varied and were not always met. We recommend strengthening communication and protocols for palliative care involvement that meet the needs of specific patient populations and physician teams for surgical and nonsurgical patients. More research is needed to better understand how to integrate palliative care into oncologic and surgical care with gynecologic oncologists.

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