Comfort and Knowledge: Nurse-Driven Palliative Care Screenings on Admission to the Neuro ICU

Abstract

It is estimated that 20% of patients will die in the intensive care unit (ICU) or shortly after discharge (Kapo & Siegel, 2013). Patients with neurological conditions account for 10-15% of all ICU admissions (Kramer & Zygun, 2014). Mortality rates for common conditions including intracerebral hemorrhage and anoxic brain injury range above 50% and the majority of survivors leave with some degree of disability or cognitive deficits (Frontera et al., 2015). Neurocritical illness outcomes are unpredictable making prognostication difficult. This can prolong hospitalization and delay defining goals of care, particularly with life limiting or life-sustaining treatments (Frontera et al., 2015).

The Neurosurgical ICU (neuro ICU) patients are not routinely screened for palliative care (PC) consultations. Unmet palliative care needs can result in inadequate symptom management, delayed established goals of care, increased length of stay and decreased patient and family satisfaction. The purpose of this project was to determine if implementing an education intervention and screening tool could increase nurse comfort and knowledge in recommending palliative care consults. There is no consistent process to integrate palliative care in the Neuro ICU despite the literature supporting early palliative care screening (Baker, Luce & Bosslet, 2015; Cortez et al., 2015; Weissman & Meier, 2011).

An electronic survey on comfort and knowledge of PC was distributed to nurses before and after the intervention. The intervention consisted of education about the Center to Advance Palliative Care (CAPC) definition of PC, review of patient case studies, and hands-on use of the screening tool. Data was collected during six-weeks of nurse-driven screening on admission.

The nurses’ comfort with assessing for PC consults increased from 62.5% to 91.7% and requesting consults from a physician, 58.4% to 75%. Nurses’ knowledge of PC being compatible with aggressive treatment increased from 41.7% to 95.8%. Nurses recommended PC in 66.7% of cases that three or more screening criteria selected.The data suggested that implementing a screening tool and education intervention can increase nurses’ comfort and knowledge in recommending palliative care consults. The screening tool highlighted that more than 62% of patients in the Neuro ICU had a palliative care need.

Key words: Palliative care. Neuro ICU. Palliative care screening/triggers.