A Nurse-Driven Screening Process to Increase ICU Palliative Care Utilization

Purpose A scholarly project aimed to increase palliative care by 25% for intensive care unit patients in eight weeks by integrating nurse-driven screening process into multidisciplinary rounds. Background Palliative care provides valuable mental, emotional, and spiritual support for patients and families. These benefits are available to any patient with a disease process causing symptoms affecting quality of life. Palliative care is falsely equated with hospice care, leading to further delay. The original referral model relied only on intensivist identification of eligibility The project was implemented in a 20-bed medical and surgical ICU in a community hospital in the Houston area. Methodology Four two-week Plan-Do-Study-Act (PDSA) cycles were performed. Baseline data collection and provider and staff education comprised the first PDSA cycle. During the subsequent three PDSA cycles, the PCST results for each patient discussed were presented during the case management portion of multidisciplinary rounds and referral data were collected. Results were displayed as a run chart, updated weekly, for ICU staff and providers, promoting project engagement. Results Of 171 ICU patients, 72 were eligible and received palliative care referrals. Referrals increased from 31.3% at baseline to 100% of eligible patients throughout the fourth PDSA cycle. Implications Integration of a nurse-driven PCST in ICU multidisciplinary rounds increases palliative care use and improves patient care. Future projects could integrate the PCST into existing multidisciplinary rounds for non-ICU acute care units to increase referral of eligible acute care patients.