Problem: The death of a loved one is a powerful stressor occurring in every person’s life. Bereavement is a unique period of physiologic and psychological adaptation occurring over time after a loved one dies. Grieving is characterized by symptoms of depression, anxiety, anger, and physical alterations in health that may last weeks and months. Providing support to family caregivers, throughout the patient’s illness and death, is one core function of palliative care. Furthermore, palliative care guidelines recommend providing grief support to families and caregivers during the bereavement period. Hospice agencies are required to provide grief support to families for a period of thirteen months after death and have formalized bereavement support programs. In contrast, many hospitals do not routinely assess bereavement risks or have formalized bereavement support programs. Hospital-based bereavement programs tend to be informal with generic interventions. There is a paucity of evidence about methods for assessing bereavement risks in families when patients die in the hospital. There is little evidence in the literature about what grief support interventions are most effective or most needed in the acute care setting.
Project Aim: The purpose of this project was to select a bereavement risk assessment tool and implement its use in a hospital setting. The tool should assess risks for complicated grief in family members experiencing the death of a loved one in the hospital. Bereavement risks will be scored into low, medium, or high-risk categories according to the public health model of bereavement support. Once the risk category has been identified, then grief support interventions would be matched to the needs of the individual.
Project Method: This quality improvement project was designed and implemented using a microsystems approach. A systematic literature review was conducted to search for clinical practice guidelines and existing bereavement risk assessment tools. Institutional criteria were identified for risk assessment tool characteristics and a comparison table created to evaluate the tools reported in the literature. As a result, one tool met all criteria for use in acute care and thus was implemented. The Palliative Care team received training in the use of the tool before and during implementation. Post-implementation data were analyzed using run charts and comparison tables.
Findings: Review of the literature supports the use of an assessment tool to assess potential bereavement risks. Although numerous tools are in use in a variety of settings, no tools were specifically developed for use in hospital settings. While the initial sample size was limited, the selected tool mirrored the public health model of bereavement support in results.
Conclusions: A bereavement risk assessment tool was selected and implemented as a quality improvement project. Barriers were addressed in uptake of the tool, adaptation of the tool to the electronic medical record, and in documenting risk assessments. Corrective actions were implemented to facilitate use of the tool. Due to a limited sample size and resources, more data is needed regarding use patterns and effectiveness of the tool prior to implementing at a unit or institutional level. Interestingly, a potential model of grief support was developed from the project that warrants further research
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