The relationship between the timing of a palliative care consult and utilization outcomes for ventilator-assisted intensive care unit patients

2013 ◽  
Vol 13 (2) ◽  
pp. 217-221 ◽  
Author(s):  
Salonie Pereira ◽  
Andrzej Kozikowski ◽  
Renee Pekmezaris ◽  
Suzanne Sunday ◽  
Tanveer Mir ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Care Delivery ◽  
Retrospective Chart Review ◽  
Improve Patient Care ◽  
Medication Costs ◽  
Number Of Patients ◽  
Before And After ◽  
The Relationship

AbstractObjective:Given the great number of chronic care patients facing the end of life and the challenges of critical care delivery, there has been emerging evidence supporting the benefit of palliative care in the intensive care unit (ICU). We studied the relationship between the timing of a palliative care consult (PCC) and two utilization outcomes — length of stay (LOS) and pharmacy costs — in ventilator-assisted ICU patients.Method:A retrospective chart review was conducted (N = 90). Summed pharmacy costs were compared using a paired t test before and after PCC. Spearman correlations were performed between days to PCC and ICU LOS, ventilator days, and days to death following ventilator discontinuation.Results:Number of days from admission to PCC was correlated with total days on ventilator (ρ = 0.685, p < 0.0001) and total ICU LOS (ρ = 0.654, p < 0.0001). Number of days to PCC was correlated with pre-PCC total medication costs (ρ = 0.539, p < 0.0001). Median medication costs were significantly reduced after the PCC (p < 0.0001), from $230.96 to 30.62. Median medication costs decreased for all categories except for analgesics, antiemetics, and opioids. The number of patients receiving opioid infusion increased (37 vs. 90%) after PCC (p < 0.0001).Significance of results:Earlier timing for PCC in the ICU is associated with a lower LOS through quicker mechanical ventilation (MV) withdrawal, presenting a unique opportunity to both decrease costs and improve patient care.

scholarly journals THE RELATIONSHIP BETWEEN NURSES' PERCEPTIONS AND SELF-EFFICACY IN IMPLEMENTING PALLIATIVE CARE IN THE INTENSIVE CARE UNIT

2018 ◽  
Author(s):  
Theresia Avila Kurnia ◽  
Yanny Trisyani ◽  
Ayu Prawesti
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Self Efficacy ◽  
Pearson Correlation ◽  
Univariate Analysis ◽  
Bivariate Analysis ◽  
Number Of Patients ◽  
Negative Perceptions ◽  
The Relationship

Background: The increasing need for palliative care in intensive care unit (ICU) is indicated by the increasing number of patients with critical and terminal conditions or life-threatening diseases. A comprehensive handling through palliative care by nurses is needed. Self-efficacy is the main predictor that influences the application of palliative care in ICU. Therefore, nurses should have high self-efficacy in order to provide qualified palliative care for patients and their families.Objective: This study aimed to analyze the relationship between perceptions and self-efficacy of nurses in applying palliative care in ICU.Methods: This study was a correlational study with a cross sectional approach. The sampling technique used was total sampling, which involved all nurses who were actively working at the Bandung General Hospital during the study. There were 127 people in total. Data were collected using questionnaires. Descriptive analysis was used for the univariate analysis and Pearson correlation test was used for bivariate analysis.Results: The results of univariate analysis showed that the majority of respondents had high self-efficacy (56.7%) and negative perceptions (52%) related to palliative care in the intensive room. Based on the results of bivariate analysis, there was a significant relationship between perception and self-efficacy variables (p value = 0.000).Conclusion: The results showed that high number of respondents had negative perceptions related to their competences in implementing palliative care in the ICU. Therefore, socializations and trainings related to this are needed, which focus on nurses' beliefs in their abilities.

scholarly journals Relationships Among Palliative Care, Ethical Climate, Empowerment, and Moral Distress in Intensive Care Unit Nurses

2018 ◽  
Vol 27 (4) ◽  
pp. 295-302 ◽  
Author(s):  
Krista Wolcott Altaker ◽  
Jill Howie-Esquivel ◽  
Janine K. Cataldo
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Ethical Climate ◽  
Moral Distress ◽  
Care Delivery ◽  
National Database ◽  
Palliative Care Teams ◽  
Intensive Care Unit Nurses ◽  
Distress Scale

Background Intensive care unit nurses experience moral distress when they feel unable to deliver ethically appropriate care to patients. Moral distress is associated with nurse burnout and patient care avoidance. Objectives To evaluate relationships among moral distress, empowerment, ethical climate, and access to palliative care in the intensive care unit. Methods Intensive care unit nurses in a national database were recruited to complete an online survey based on the Moral Distress Scale–Revised, Psychological Empowerment Index, Hospital Ethical Climate Survey, and a palliative care delivery questionnaire. Descriptive, correlational, and regression analyses were performed. Results Of 288 initiated surveys, 238 were completed. Participants were nationally representative of nurses by age, years of experience, and geographical region. Most were white and female and had a bachelor’s degree. The mean moral distress score was moderately high, and correlations were found with empowerment (r = −0.145; P = .02) and ethical climate scores (r = −0.354; P &lt; .001). Relationships between moral distress and empowerment scores and between moral distress and ethical climate scores were not affected by access to palliative care. Nurses reporting palliative care access had higher moral distress scores than those without such access. Education, ethnicity, unit size, access to full palliative care team, and ethical climate explained variance in moral distress scores. Conclusions Poor ethical climate, unintegrated palliative care teams, and nurse empowerment are associated with increased moral distress. The findings highlight the need to promote palliative care education and palliative care teams that are well integrated into intensive care units.

Overestimation of Bispectral Index in Sedated Intensive Care Unit Patients Revealed by Administration of Muscle Relaxant

2003 ◽  
Vol 99 (1) ◽  
pp. 9-17 ◽  
Author(s):  
Benoît Vivien ◽  
Sophie Di Maria ◽  
Alexandre Ouattara ◽  
Olivier Langeron ◽  
Pierre Coriat ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neuromuscular Blockade ◽  
Bispectral Index ◽  
Muscle Relaxant ◽  
Muscular Activity ◽  
Electromyographic Activity ◽  
Adductor Pollicis Muscle ◽  
Number Of Patients ◽  
Before And After

Background Electromyographic activity has previously been reported to elevate the Bispectral Index (BIS) in patients not receiving neuromuscular blockade while under sedation in the intensive care unit. This study aimed to investigate the magnitude of the decrease of BIS following administration of muscle relaxant in sedated intensive care unit patients. Methods The authors prospectively investigated 45 patients who were continuously sedated with midazolam and sufentanil to achieve a Sedation-Agitation Scale value equal to 1 and who required administration of muscle relaxant. BIS (BIS version 2.10), electromyography, and acceleromyography at the adductor pollicis muscle were recorded simultaneously before and after neuromuscular blockade. Sixteen of these 45 patients were also studied simultaneously with the new BIS XP. Results After administration of a muscle relaxant, BIS (67 +/- 19 vs. 43 +/- 10, P &lt; 0.001) and electromyographic activity (37 +/- 9 vs. 27 +/- 3 dB, P &lt; 0.001) significantly decreased. Multiple regression analysis showed that the decrease of BIS following administration of myorelaxant was significantly correlated to BIS and electromyographic baseline values. Using standard BIS range guidelines, the number of patients under light or deep sedation versus general anesthesia or deep hypnotic state was markedly overestimated before administration of myorelaxant (53 vs. 2%, P &lt; 0.001). Conclusions The BIS in sedated intensive care unit patients may be lower with paralysis for an equivalent degree of sedation because of high muscular activity. The magnitude of BIS overestimation is significantly correlated to both BIS and electromyographic activity before neuromuscular blockade. The authors conclude that clinicians who determine the amount of sedation in intensive care unit patients only from BIS monitoring may expose them to unnecessary oversedation.

scholarly journals Factors Associated with Nurses’ Self-Efficacy in Applying Palliative Care in Intensive Care Unit

Jurnal NERS ◽  
2019 ◽  
Vol 13 (2) ◽  
pp. 219 ◽  
Author(s):  
Theresia Avila Kurnia ◽  
Yanny Trisyani ◽  
Ayu Prawesti
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Self Efficacy ◽  
Pearson Correlation ◽  
Nursing Profession ◽  
Bivariate Analysis ◽  
Comprehensive Treatment ◽  
Number Of Patients ◽  
Spearman Test

Introduction: The increasing need for palliative care (PC) in the intensive care unit (ICU) is characterised by an increasing number of patients with critical and terminals conditions. It requires comprehensive treatment of nurses, through PC. Self-efficacy is a major predictor that affects the application of PC in ICU. Therefore, nurses need to have high self-efficacy to provide quality PC for patients and their families. This study aimed to analyse the factors that dominant relates to nurses' self-efficacy in implementing of providing PC in ICU.Methods: This research was correlational research with cross-sectional survey design. The sampling technique used was total sampling, which involved 127 critical nurses who were actively working at a general hospital in Bandung, Indonesia. Data were collected using questionnaires. Bivariate analysis using Pearson correlation and Rank-Spearman test and multivariate analysis using linear regression.Results: The results showed that the majority of respondents had high self-efficacy, working experience >15 years, enough interest to the nursing profession had less knowledge and negative perception related to the PC in ICU. There was a significant relationship between self-efficacy with work experience, nurses' interest in the nursing profession, knowledge and perception variables. The most dominant factors related to self-efficacy, namely knowledge and perceptions of nurses related to PC.Conclusion: This study indicates that majority of the respondents lacked knowledge and had negative perceptions related to PC in ICU, it is necessary to socialise and training related to it by focusing on self-belief or self-efficacy of nurses on their ability.

Outcomes Associated With a Nurse-Driven Palliative Care Screening Tool in the Intensive Care Unit

2020 ◽  
Vol 40 (3) ◽  
pp. 23-29
Author(s):  
Kim Martz ◽  
Jenny Alderden ◽  
Rick Bassett ◽  
Dawn Swick
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Screening Tool ◽  
Care Delivery ◽  
Screening Tools ◽  
Discharge Disposition ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
To Receive

Background Access to specialty palliative care delivery in the intensive care unit is inconsistent across institutions. The intensive care unit at the study institution uses a screening tool to identify patients likely to benefit from specialty palliative care, yet little is known about outcomes associated with the use of screening tools. Objective To identify outcomes associated with specialty palliative care referral among patients with critical illness. Methods Records of 112 patients with positive results on palliative care screening were retrospectively reviewed to compare outcomes between patients who received a specialty palliative care consult and those who did not. Primary outcome measures were length of stay, discharge disposition, and escalation of care. Results Sixty-five patients (58%) did not receive a palliative care consult. No significant differences were found in length of hospital or intensive care unit stay. Most patients who experienced mechanical ventilation did not receive a palliative care consultation (χ2 = 5.14, P = .02). Patients who were discharged to home were also less likely to receive a consult (χ2 = 4.1, P = .04), whereas patients who were discharged to hospice were more likely to receive a consult (χ2 = 19.39, P &lt; .001). Conclusions Unmet needs exist for specialty palliative care. Understanding the methods of identifying patients for specialty palliative care and providing them with such care is critically important. Future research is needed to elucidate the factors providers use in their decisions to order or defer specialty palliative care consultation.

Unnecessary wait hours: a novel ED system-level metric

2020 ◽  
Vol 37 (9) ◽  
pp. 552-554
Author(s):  
Heather A Heaton ◽  
David M Nestler ◽  
Kalyan S Pasupathy ◽  
Phichet Wutthisirisart ◽  
Mustafa Y Sir ◽  
...  
Keyword(s):  
Opposite Effect ◽  
Care Delivery ◽  
System Level ◽  
Space Efficiency ◽  
A Value ◽  
Number Of Patients ◽  
Before And After ◽  
Ed Operations ◽  
The Relationship

BackgroundEmergency department (ED) operations leaders are under increasing pressure to make care delivery more efficient. Publicly reported ED efficiency metrics are traditionally patient centred and do not show situational or facility-based improvement opportunities. We propose the consideration of a novel metric, the ‘Number of Unnecessary Waits (NUW)’ and the corresponding ‘Unnecessary Wait Hours (UWH)’, to measure space efficiency, and we describe how we used NUW to evaluate operational changes in our ED.MethodsUWH summarises the relationship between the number of available rooms and the number of patients waiting by returning a value equal to the number of unnecessary patient waits. We used this metric to evaluate reassigning a clinical technician assistant (CTA) to the new role of flow CTA.ResultsWe retrospectively analysed 3.5 months of data from before and after creation of the flow CTA. NUW metric analysis suggested that the flow CTA decreased the amount of unnecessary wait hours, while higher patient volumes had the opposite effect.ConclusionsSituational system-level metrics may provide a new dimension to evaluating ED operational efficiencies. Studies focussed on system-level metrics to evaluate an ED practice are needed to understand the role these metrics play in evaluation of a department’s operations.

scholarly journals Examining Perceptions of Computerized Physician Order Entry in a Neonatal Intensive Care Unit

2017 ◽  
Vol 08 (02) ◽  
pp. 337-347 ◽  
Author(s):  
Kristyn Beam ◽  
Megan Cardoso ◽  
Megan Sweeney ◽  
Geoff Binney ◽  
Saul Weingart
Keyword(s):  
Job Satisfaction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Care Delivery ◽  
Computerized Physician Order Entry ◽  
Order Entry ◽  
Before And After ◽  
Physician Order Entry

SummaryBackground: Computerized provider order entry (CPOE) is a technology with potential to transform care delivery. While CPOE systems have been studied in adult populations, less is known about the implementation of CPOE in the neonatal intensive care unit (NICU) and perceptions of nurses and physicians using the system.Objective: To examine perceptions of clinicians before and after CPOE implementation in the NICU of a pediatric hospital.Methods: A cross-sectional survey of clinicians working in a Level III NICU was conducted. The survey was distributed before and after CPOE implementation. Participants were asked about their perception of CPOE on patient care delivery, implementation of the system, and effect on job satisfaction. A qualitative section inquired about additional concerns surrounding implementation. Responses were tabulated and analyzed using the Chi-square test.Results: The survey was distributed to 158 clinicians with a 47% response rate for pre-implementation and 45% for post-implementation. Clinicians understood why CPOE was implemented, but felt there was incomplete technical training. The expectation for increased job satisfaction and ability to recruit high-quality staff was high. However, there was concern about the ability to deliver appropriate treatments before and after implementation. Physicians were more optimistic about CPOE implementation than nurses who remained concerned that workflow may be altered.Conclusions: Introducing CPOE is a potentially risky endeavor and must be done carefully to mitigate harm. Although high expectations of the system can be met, it is important to attend to differing expectations among clinicians with varied levels of comfort with technology. Interdisciplinary collaboration is critical in planning a functioning CPOE to ensure that efficient workflow is maintained and appropriate supports for individuals with a lower degree of technical literacy is available.Citation: Beam KS, Cardoso M, Sweeney M, Binney G, Weingart SN. Examining perceptions of computerized physician order entry in a neonatal intensive care unit. Appl Clin Inform 2017; 8: 337–347 https://doi.org/10.4338/ACI-2016-09-RA-0153

The relationship between nurses' knowledge and self-confidence in implementing palliative care in an intensive care unit

2020 ◽  
Vol 26 (4) ◽  
pp. 183-190
Author(s):  
Theresia Avila Kurnia ◽  
Yanny Trisyani ◽  
Ayu Prawesti
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Pearson Correlation ◽  
Univariate Analysis ◽  
Sampling Technique ◽  
Bivariate Analysis ◽  
Cross Sectional ◽  
Self Confidence ◽  
The Relationship

Background: This quantitative study aimed to analyse the relationship between knowledge and nurses' self-confidence (or self-efficacy) in applying palliative care (PC) in the intensive care unit (ICU). This study was a correlational study with a cross-sectional approach. The sampling technique used was total sampling, and the sample included all nurses who were actively working at the general hospital in Bandung, West Java, Indonesia, during the study. There were 127 people in total. Data were collected using questionnaires. The Pearson correlation test was used for bivariate analysis. The results of univariate analysis showed that the majority of respondents had high self-confidence but had less knowledge related to PC in the ICU. Based on the results of the bivariate analysis, there was a significant relationship between knowledge and self-confidence variables. The results showed that a high number of respondents had less knowledge in implementing PC in the ICU. Therefore, familiarisation sessions and training related to this are needed, focusing on nurses' beliefs in their abilities.

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