Background Prior to the COVID-19 pandemic, an estimated 10–20% of the UK population died in the intensive care unit (ICU).¹ Approximately 70% of these deaths occur after decisions to withhold or withdraw life-sustaining treatments.² During the pandemic (April 2020-March 2021), one acute London hospital trust reported delivering increased end-of-life care (EOLC) on ICU (with 39.9% of deaths occurring in ICU).

An individualised EOLC plan was in use across the trust to support people in their last days of life, however this was used infrequently in ICU.

Methods A staff survey revealed the need for ICU specific EOLC plans, training on difficult discussions and empowerment of nursing staff to collaborate in decision making. These findings align with the literature on EOLC in ICU.³ A multidisciplinary working group devised a template for an ICU-specific individualised EOLC plan. The template was presented at grand round, an educational program on EOLC was delivered to ICU nursing staff, and a series of workshops on difficult conversations commenced with ICU junior doctors.

Results In the four months following the rollout of the care plan 29.9% (20/67) of people who died in ICU had an individualised care plan. This represents a 69.8% increase from baseline. Workshops on difficult conversations were evaluated positively by attendees.

Conclusions The described interventions led to increased awareness of EOLC among ICU staff and an improvement in number of patients having an individualised care plan at EOL.

Next steps ongoing review of the EOLC plan using quality improvement methodology; development of a checklist for withdrawal of invasive organ support at the end of life; continuation of the education programme.

References

1. Connolly C, Miskolci O, Phelan D, Buggy D. End-of-life in the ICU: moving from ‘withdrawal of care’ to a palliative care, patient-centred approach. British Journal of Anaesthesia, 2016;117(2):143–145. https://doi.org/10.1093/bja/aew109

2. Sprung CL, Cohen SL, Sjokvist P, Baras M, Bulow HH, Hovilehto S, Ledoux D, Lippert A, Maia P, Phelan D, Schobersberger W, Wennberg E, Woodcock T, For The Ethicus Study Group. End-of-Life Practices in European Intensive Care Units. JAMA, 2003;290(6):790. https://doi.org/10.1001/jama.290.6.79

3. Griffiths I. What are the challenges for nurses when providing end-of-life care in intensive care units?. British Journal of Nursing, 2019;28(16):1047–1052.