Background End of life care (EOLC) on intensive care units (ICU) comes with a number of challenges. This includes rapidly deteriorating patients, complex decisions regarding the withdrawal/cessation of medical interventions, specific care needs for sedated patients, and psychological considerations for grieving family and friends.
Methods A multiple cycle QIP was carried out at Newham University Hospital. EOLC in ‘expected deaths’ was audited against local guidance. This is summarised in the Barts Health individualised care plan for the dying patient; Compassionate Care Plan (CCP). Data was collected through review of mortality lists and electronic patient records. Further cycles were completed following interventions; firstly, EOLC trollies with information for staff, patients and families, alongside creating a designated EOLC champion nursing role. Secondly teaching sessions on EOLC.
Results Initial data was taken from the two month period May-June 21. There were 14 expected deaths: 4 patients were referred to palliative care (29%); 2 patients were supported with the CCP; 2 patients had documentation into consideration of spiritual support. For patients not sedated, medications for symptom control were not always prescribed.
Following the first interventions, Jan-Mar 2022 was analysed. There were 23 expected deaths: 8 (35%) were referred to palliative care,; 6 patients (26%) were supported with the CCP; 12 patients had documentation pertaining to symptom control; 9 (39%) patients had documentation of their spiritual needs, with chaplain visits.
Following the second intervention, a further two-month period was assessed. There were 14 expected deaths: 50% were referred to palliative care; 6 patients had documented considerations into spiritual care; un-sedated patients had their symptoms assessed through documented discussion with them.
Conclusions This QIP demonstrated interventions such as education, a designated EOLC champion and easily accessible resources increased spiritual care considerations, improved management of patient’s symptom control needs and increased referrals to the palliative care team.
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