Intensive Care Unit Nurses and Palliative Care: Perceptions and Recommendations (S706)

Abstract

3. Review the essential elements and components of an inpatient palliative program implemented in a rural community safety net hospital in an era of cost containment. Background. There is a plethora of data detailing the utilization of inpatient palliative care programs (IPCPs). However, the data is dominated by academic centers including urban/suburban facilities. There is a lack of data regarding rural safety net facilities (RSNF) primarily serving the medically indigent. The medically indigent represent a vulnerable population that historically has been ignored regarding access to palliative care. Research Objectives. To assess the impact of an IPCP in a RSNF in south Louisiana regarding hospital/ICU deaths, palliative care and withdrawal of life support order set utilization, ICU codes, and patient days and hospice referrals. Method. An IPCP was implemented in July 2008 and consisted of providers, nursing staff, social workers, and others formed a palliative care team in 2007 at Chabert Medical Center in Houma, LA. Other components included a consult service, an evidence-based palliative care and withdrawal of care order set, an educational campaign for patients and employees including medical students and residents that includes a lecture series, updated end of life facility policies, a dedicated palliative care suite, and pamphlets and printed literature available for patients and family members in high utilization areas. A quality of care palliative care registry was created and data was tracked from 2005 (3 years prior to program inception) to early 2012. Result. Hospital deaths were reduced by 1518% and ICU deaths by 12.5-15%. Palliative care order set utilization increased from 28% in 2008 to 55% in 2010/2011, ICU deaths were reduced 10%, withdrawal of life support order set use increased from 28% in 2008 to 50% in 2011, ICU codes remained unchanged, ICU patient days fell 20%, and hospice referrals have increased 40-45%. Conclusion. An IPCP implemented at an RSNF may successfully reduce resource utilization and increase hospice referrals. Implications for Research, Policy, or Practice. IPCPs can be implemented successfully at rural safety net facilities primarily serving the medically indigent. Intensive Care Unit Nurses and Palliative Care: Perceptions and Recommendations (S706) Rebecca Aslakson, MDMSci, The Johns Hopkins University School of Medicine, Baltimore, MD. Erica Koegler, MA, Johns Hopkins School of Public Health, Baltimore, MD. Rita Moldovan, RN DNP ACHPN, Johns Hopkins Hospital, Baltimore, MD. Kerry Shannon, MPH, Johns Hopkins University, Baltimore, MD. Jessica Peters Johns Hopkins University, Baltimore, MD. Lauren Redstone, MA, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Selena An, BA, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Jeffrey Duong, MHS, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Erica Koegler, MA, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Maya Nadison Johns Hopkins University, Baltimore, MD. Peter Pronovost, MD PhD FCCM, Johns Hopkins Medicine, Baltimore, MD. (All authors listed above had no relevant financial relationships to disclose.)