Paper
Friday, July 15, 2005
Palliative Care of Chronically Ill Patients
Carma J. Erickson-Hurt, APRN-BC, Medical-Surgical Nursing Department, Naval Medical Center, San Diego, CA, USA and Linnea Marie Axman, DrPH, MSN, C-FNP, Nursing Research and Analysis, Naval Medical Center San Diego, San Diego, CA, USA.
Background: Dying patients continue to receive care in acute care hospital settings until the time of death. Death in hospitals is usually predictable, yet rarely well managed. Studies have demonstrated considerable unmet need for symptom control, psychological and social support, and communication among patients who die from chronic illnesses and their families. In response to these concerns, hospital-based palliative care programs have developed. Education and specialty training in palliative care improves outcomes. Objective: (1) Examine the effect of palliative care for chronically ill patients; (2) measure outcomes of evidence-based guidelines for comfort care; and (3) measure clinician adherence to evidence-based practices. Methods: A palliative care team was formed to review the evidence, provide recommendations, and develop a standardized protocol for patient's transferred from acute care units for “comfort measures only”. The Iowa Model of Research Based Practice to Promote Quality Care guided development of the protocol. The team designated two inpatient rooms as “comfort care suites” and implemented the Comfort Care Protocol in December 2004. The protocol serves as an educational tool and guide for health care providers caring for this population of patients. Outcomes measures assess pain level, skin condition, breathing, elimination and other symptom control. Retrospective record reviews will compare outcomes for patients prior to and following implementation of the Comfort Care Protocol. Findings: Because the protocol was just implemented, reliable results are not available. Early evidence suggests that the transfer of dying patients from the Intensive Care Unit to comfort care suites for the final hours before death results in greater patient, family, and provider satisfaction with the care environment and cost savings to the institution. Providers have related that they enjoy greater collaboration in a setting in which nurse, patient, and physician are active participants in comfort care decision-making.