Screening of ICU Patients for Palliative and Hospice Care

The purpose of this quality improvement project was to create an intensive care unit (ICU) admission screening tool for nurses to assess patient qualification for palliative and hospice care programs. Few medical facilities in the US currently use a specific screening tool to identify patients who qualify for end-of-life care programs. The usual process for understanding a patient's desires about end-of-life care is delayed until a nurse or other health provider randomly decides to clarify these wishes and goals. Many patients admitted to a hospital ICU qualify for palliative care or hospice programs, but timely explanation of these options is rare, which may result in unfulfilled patient wishes. About one in five Americans dies inside an ICU. Often, patients in the ICU are unprepared for an adverse outcome and do not have advance directives that detail their desires. About 26% of the U.S. population and about 67% of seriously ill patients have an advance directive. Although advance directives may help in guiding end-of-life care, they often fall short due to a lack of specific details that match patients' conditions. This leaves their long-term or terminal desires unknown to their families and others who care for them. Furthermore, patients may lose the ability to communicate their desires as their situation worsens. In addition, there is a significant delay in ICU medical teams initiating an inquiry about the patients' care desires. This delay may increase unwanted and expensive medical procedures and the length of the hospital stay. An admission checklist is needed to expedite the identification of ICU patients who could benefit from a consultation on end-of-life care. The purpose of this project was to expedite medical team knowledge of patient care desires and end-of-life wishes in the ICU. The project objectives were to (a) create a palliative care and hospice checklist, (b) increase ICU nurses' knowledge of palliative and hospice care, (c) pilot test the checklist for screening ICU patients, and (d) disseminate the project results. Nurse-participants engaged in a learning module that informed them about palliative and hospice care and how to educate patients and families about these services. They then used the checklist with 45 patients and provided feedback for revisions of the checklist. Participants' knowledge was assessed by comparing pre- and post-questionnaires. The results of the project will be disseminated after acceptance of an abstract for a poster presentation at the 2nd Annual Excellence in Trauma Care Conference. The checklist was also given to the project system of hospitals to use in their ICUs.