Increasing Palliative Care Consultation Through a Nurse-Driven Screening Protocol on a Medical-Surgical Unit

Palliative care consultation frequently occurs late in hospitalization despite known benefits for symptom management and care planning. Nurses often recognize unmet needs but may hesitate to initiate referral because of uncertainty, misconceptions, and reliance on physician direction. Lack of standardized identification processes contributes to inconsistent and potentially inequitable access to palliative services. This quality improvement project evaluated whether a nurse-driven screening tool combined with targeted education increased palliative care consultation rates and nursing knowledge on a medical-surgical unit. A plan-do-study-act framework was implemented on a 31-bed adult medical-surgical unit where 20 nurses participated in education and used the screening tool during admission and transfer assessments. Consultation rates increased from 3 referrals in 8 weeks before implementation to 8 referrals in 8 weeks after implementation, and all referrals were determined appropriate by the palliative care team. Nursing knowledge scores improved substantially following education. These findings suggest that structured nurse-driven screening can strengthen nursing advocacy, support earlier identification of unmet palliative needs, and promote more consistent access to palliative care consultation in acute care settings.