Utilization of a nurse-driven palliative screening tool in the intensive care unit
Description
TitleUtilization of a nurse-driven palliative screening tool in the intensive care unit
Date Created2023
Other Date2023-01 (degree)
Extent99 pages : illustrations
DescriptionPurpose of the Project: The standard use of a palliative screening tool that contains triggers fosters early patient recognition for a palliative referral. Yet despite national guidelines that elevate the use of palliative trigger criteria, practice gaps exist widely across practice settings, leaving patients with unmet palliative needs. A voluntary palliative referral by the intensivists was the practiced norm at the project site, but little was known of its efficacy. The purpose of the project focused on standardizing the structure and process of referral through a nurse-driven palliative screening tool to enhance early referral and promote timely goals-of-care discussions with patients and families. Methodology: Pre- and post-implementation surveys measured critical care nurses’ screening comfort level, and the screening tool’s usability, productivity, acceptability, and sustainability, respectively. A comparison of records from 200 admitted ICU patients in a pre-and post-implementation design illustrated the value of a nurse-driven palliative screening within a six-week project duration. The primary outcome measures focused on palliative referral rate, referral timeliness, the prompting of, and initiation of a goals-of-care discussion, and the end outcome.
Results: The pre-implementation survey on screening comfortability (N = 50) showed that most respondents were strongly comfortable (n = 22, 44%), comfortable (n = 21, 42%), and neutral (n = 7, 14%). A statistically significant variation between the two groups in palliative referral rate (X2(1) = 120.22, p = .000, Phi = .97), timeliness in referral and subsequent consultation (t = 3.10(9), p = .013), and incidence of goals-of-care discussions (10% to 59%), with symptom management as the leading end-outcome (X2(1) = 14.78, p = .000, Phi = .46) were apparent. The post-implementation survey (N = 50) revealed that respondents strongly agreed the tool was easy to use (n = 49, 98%), and would recommend its continued use (n = 47, 94%).
Implications for Practice: The execution of the intervention and its favorable results supports the utility of a nurse-driven palliative screening tool in the objective recognition of patients that will likely benefit from palliative care.
NoteD.N.P.
NoteIncludes bibliographical references
Genretheses
LanguageEnglish
CollectionSchool of Nursing (RBHS) DNP Projects
Organization NameRutgers, The State University of New Jersey
RightsThe author owns the copyright to this work.
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