Background Managing transition from the Intensive Care Unit (ICU) to a ward bed for end of life care is often fraught with challenges. Ensuring the transition is seamless requires withdrawal of inappropriate interventions, prescribing of appropriate medications for ongoing symptom management and ongoing supportive communication for patients and families.
At St George Hospital in Sydney, Australia in 2014, 40 patients were referred to the Palliative Care Team for end of life care from ICU. 21 died in ICU, 11 in a ward bed and 7 were discharged.
Aim To develop and implement a tool to operationalize seamless transfer of patients from ICU to the wards for end of life care.
Methods Senior nursing staff from ICU and Palliative Care collaborated to develop an Intensive Care End of Life Care Plan. Using the Liverpool End of Life Pathway (UK) and the Liverpool Hospital (Sydney, Australia) ICU End of Life Pathway as a guide parameters of care were altered to reflect the complex nature of ICU patients as they transition from active to conservative care.
Results The completed tool is currently being implemented and evaluation has commenced.
Discussion This process relied on the unique relationship between Palliative Care and ICU staff.
Conclusion Embedding a change in culture within the ICU to include palliative care takes time and effective communication. Better outcomes for patients and their families is the aim and empowering medical and nursing staff in the ICU to confidently provide good end of life care is paramount to achieving this.
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