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Implementation of an End of Life Care Protocol for Patients on an Intermediate Pulmonary Care Unit
Description
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A4883 - Implementation of an End of Life Care Protocol for Patients on an Intermediate Pulmonary Care Unit
Author Block: L. Chiec, A. Frogameni, S. R. Russell; Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
Rationale:
Caring for patients with chronic lung disease at the end of life presents unique challenges, including coordination of advanced respiratory devices and managing dyspnea. We previously found that less than 50% of residents on an intermediate pulmonary medicine unit felt comfortable with the use of advanced respiratory devices at the end of life. The objective of this study was to evaluate change in provider comfort and use of an end of life protocol after its implementation on an intermediate pulmonary care unit.
Methods:
An end of life order set was created and made available April 1, 2017. An informational guide for providers was created, and nurses and physicians on the unit received education regarding use of the protocol. Chart review of patients receiving end of life care on the unit from April 1, 2017-September 24, 2017 was completed and characteristics of patients and compliance with the order set was measured in comparison to a pre-intervention dataset. Residents were surveyed from July-September, 2017 and responses were compared to surveys conducted prior to the intervention in April 2016.
Results:
After implementation of the protocol, the average monthly number of patients receiving end of life care on the unit increased from 4.25 to 7.66. Compliance with the order set was 30.4% (14/46). The number of residents who reported providing end of life care on the unit increased from 44.19% to 68.75% (p=0.0376). An increase in resident comfort, measured by responses of “comfortable” or “very comfortable”, with the use of morphine (72.73% to 100%, p=0.0016), glycopyrrolate (68.18% to 96.67%, p=0.003), and high-flow nasal cannula (47.73% to 72.4%, p=0.0382) were seen. The percent of residents who felt comfortable with ventilator disconnection increased (36.36% to 68.97%, p=0.0068). The percent of residents who believe that nurses on the unit are comfortable providing end of life care increased from 27.91% to 58.06% (p=0.0096)
Conclusions:
Implementation of an end of life protocol for patients on an intermediate pulmonary care unit is associated with a sustained increase in patients receiving end of life care on that unit over a six-month period. It is also associated with an increase in provider comfort with specific pharmacologic treatments, as well as increased comfort with the use of advanced respiratory devices such as high-flow nasal cannula and ventilator disconnection. Continued education and use of a multidisciplinary protocol can facilitate the delivery of quality end of life care for pulmonary patients in this setting.
Author Block: L. Chiec, A. Frogameni, S. R. Russell; Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
Rationale:
Caring for patients with chronic lung disease at the end of life presents unique challenges, including coordination of advanced respiratory devices and managing dyspnea. We previously found that less than 50% of residents on an intermediate pulmonary medicine unit felt comfortable with the use of advanced respiratory devices at the end of life. The objective of this study was to evaluate change in provider comfort and use of an end of life protocol after its implementation on an intermediate pulmonary care unit.
Methods:
An end of life order set was created and made available April 1, 2017. An informational guide for providers was created, and nurses and physicians on the unit received education regarding use of the protocol. Chart review of patients receiving end of life care on the unit from April 1, 2017-September 24, 2017 was completed and characteristics of patients and compliance with the order set was measured in comparison to a pre-intervention dataset. Residents were surveyed from July-September, 2017 and responses were compared to surveys conducted prior to the intervention in April 2016.
Results:
After implementation of the protocol, the average monthly number of patients receiving end of life care on the unit increased from 4.25 to 7.66. Compliance with the order set was 30.4% (14/46). The number of residents who reported providing end of life care on the unit increased from 44.19% to 68.75% (p=0.0376). An increase in resident comfort, measured by responses of “comfortable” or “very comfortable”, with the use of morphine (72.73% to 100%, p=0.0016), glycopyrrolate (68.18% to 96.67%, p=0.003), and high-flow nasal cannula (47.73% to 72.4%, p=0.0382) were seen. The percent of residents who felt comfortable with ventilator disconnection increased (36.36% to 68.97%, p=0.0068). The percent of residents who believe that nurses on the unit are comfortable providing end of life care increased from 27.91% to 58.06% (p=0.0096)
Conclusions:
Implementation of an end of life protocol for patients on an intermediate pulmonary care unit is associated with a sustained increase in patients receiving end of life care on that unit over a six-month period. It is also associated with an increase in provider comfort with specific pharmacologic treatments, as well as increased comfort with the use of advanced respiratory devices such as high-flow nasal cannula and ventilator disconnection. Continued education and use of a multidisciplinary protocol can facilitate the delivery of quality end of life care for pulmonary patients in this setting.
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