Background Intensive Care Units have traditionally been poorly integrated with hospital specialist palliative care resources despite patients having significant morbidity and mortality. This project aimed to integrate hospital Specialist Palliative Care Team (SPCT) into the ICU by identifying challenges in providing palliative care in ICU and providing staff education.
Method Staff questionnaires were used to explore the opportunities and barriers to providing SPCT input in the ICU. SPCT and ICU staff were asked to self-rate their confidence in providing 30 core aspects of end of life identified from national guidance.1 In response to this questionnaire a programme of education, staff shadowing and joint review was established and it’s effect measured by repeated self-rating of staff confidence.
Results The initial staff survey identified significant differences in confidence between SPCT and ICU staff. SPCT staff lacked confidence in management of withdrawal of life sustaining treatment and management of invasive organ support (0% of SPCT staff extremely or very confident in managing withdrawal of invasive ventilation). In contrast critical care staff were significantly less confident in providing aspects of holistic care (0% extremely or very confident in managing spiritual care). Following our intervention there was an improvement in confidence in managing all 30 core elements of end of life care in ITU. SPCT staff were more confident in management of withdrawal of organ support (eg. NIV 50% extremely or very confident vs 8% pre-intervention) whilst ICU staff felt more able to assess and support holistic needs.
Conclusion Significant improvement in staff confidence in managing end of life care in ICU was demonstrated via a series of simple educational interventions. This enabled SPCT staff to become integrated into the ICU team and share their knowledge and skills in managing patients approaching the end of their life.
The Faculty of Intensive Care Medicine. Care at the end of life: A guide to best practice, discussion and decision-making in and around critical care, https://www.ficm.ac.uk/sites/default/files/ficm_care_end_of_life.pdf (2019, accessed 22nd August 2021).
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