Abstract
Several children receiving palliative care experience dyspnea and pain. An order protocol for distress (OPD) is available at Sainte-Justine Hospital, aimed at alleviating respiratory distress, pain and anxiety in pediatric palliative care patients. This study evaluates the clinical use of the OPD at Sainte-Justine Hospital, through a retrospective chart review of all patients for whom the OPD was prescribed between September 2009 and September 2012. Effectiveness of the OPD was assessed using chart documentation of the patient’s symptoms, or the modified Borg scale. Safety of the OPD was evaluated by measuring the time between administration of the first medication and the patient’s death, and clinical evolution of the patient as recorded in the chart. One hundred and four (104) patients were included in the study. The OPD was administered at least once to 78 (75%) patients. A total of 350 episodes of administration occurred, mainly for respiratory distress (89%). Relief was provided in 90% of cases. The interval between administration of the first protocol and death was 17 h; the interval was longer in children with cancer compared to other illnesses (p = 0.02). Data from this study support the effectiveness and safety of using an OPD for children receiving palliative care.
Highlights
Several children in palliative care experience dyspnea and pain, throughout their illness and at the end of their lives [1,2,3,4]
The following elements were retrieved from the charts and recorded: demographic data and diagnosis; data pertaining to the trajectory of patients enrolled in the study; and data related to administration of the protocol
We considered effective relief of symptoms was achieved if there was an improvement of at least 3 points between both measurements; partial relief was understood as an improvement of 1 or 2 points between both measurements; we recorded no improvement if the score was the same or worse after administration of the order protocol for distress (OPD)
Summary
Several children in palliative care experience dyspnea and pain, throughout their illness and at the end of their lives [1,2,3,4]. Relief of these symptoms is a cornerstone of palliative care [5], and a priority for research in the field [6,7]. Starting in 2009, an order protocol for distress (respiratory distress, acute pain crisis or anxiety) was established for pediatric palliative care patients at Sainte-Justine Hospital. The order protocol for distress (OPD) is a prescription template comprising opioids, benzodiazepines and anticholinergic drugs. The nurse can administer the OPD whenever the patient presents symptoms of acute distress; the physician must be notified that the OPD has been initiated
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