Implementing a Bereavement Risk Assessment in a Hospital Setting

Abstract Problem: The death of a loved one is a powerful stressor occurring in every person’s life. Bereavement is a unique period of physiologic and psychological adaptation occurring over time after a loved one dies. Grieving is characterized by symptoms of depression, anxiety, anger, and physical alterations in health that may last weeks and months. Providing support to family caregivers, throughout the patient’s illness and death, is one core function of palliative care. Furthermore, palliative care guidelines recommend providing grief support to families and caregivers during the bereavement period. While hospice agencies are required to provide grief support to families for a period of 13 months after death and have formalized bereavement support programs, many hospitals do not routinely assess bereavement risk factors or have formalized bereavement support programs. Hospital based bereavement programs tend to be informal with generic interventions. There is a paucity of evidence about methods for assessing bereavement risks in families when patients die in the hospital. There is little evidence in the literature about what grief support interventions are most effective or most needed in the acute care setting. Project Aim: The purpose of this project was to select a bereavement risk assessment tool and implement its use in a hospital setting. The tool will be used to assess risks for complicated grief in family members experiencing the death of a loved one in the hospital. Ideally, the tool will score bereavement risks in to low, medium, or high-risk categories according to the public health model of bereavement support. Once the risk category is identified, then grief support interventions can be matched to the needs of the individual. Project Method: This quality improvement project was implemented using a microsystems approach. A literature review was conducted to search for clinical practice guidelines and existing bereavement risk assessment tools. Institutional criteria were identified for a risk assessment tool and a comparison table was created to evaluate tools reported in the literature. The Palliative Care team was trained in the use of the tool before and during implementation. Additionally, a potential model of grief support applicable to acute care was developed. Grief support interventions were identified and assigned to the specific category of risk. Findings: Review of the literature supports the use of a bereavement risk assessment tool to assess grief support needs and potential bereavement risks. Risk assessment tools were screened for suitability for use in a hospital setting and then placed into a comparison table. A bereavement risk assessment tool was selected based on the criteria established for the comparison table. The tool was implemented after completing education and data collected regarding efficacy. The selected tool produced similar results to the public health model of bereavement support, however the sample size was limited. Conclusions: A bereavement risk assessment tool was selected and implemented as a quality improvement project. Barriers were encountered in uptake of the tool and in the process of documenting risk assessments in the medical record. Due to a limited sample size and resources, more data is needed regarding use and effectiveness of the tool. Additional education and training is needed prior to generalizing use of a tool to the unit or institutional level