Implementation of a palliative care screening tool in the intensive care unit: a quality improvement project

Purpose statement: The purpose of the project was to address unmet palliative care needs in the ICU by implementing a palliative care screening tool at a private, not-for-profit hospital, following The Iowa Model (Iowa Model Collaborative, 2017). Methodology: This is a quality improvement project with a retrospective and prospective chart review design. An initial retrospective chart review was performed by the principal investigator (PI) to determine how many patients received a palliative care consult over six weeks prior to the implementation of a screening tool. A palliative care screening tool was created using the guidelines provided by the Improving Palliative Care (IPAL)-ICU project. The final screening tool represents the specific ICU that it was used in and consists of eight evidence-based screening triggers. The implementation period took place over six weeks. Once this was completed, the PI performed a prospective chart review to determine the number of palliative care consults ordered during that time. Results: A total of 34 nurses consented to participate in this quality improvement project to address the need for a palliative care screening tool in the ICU to identify patients appropriate for palliative care services. The retrospective chart review from July 13th, 2020 to August 23rd, 2020, revealed 165 ICU admissions. Of those 165 patients, 21of them received a palliative care consult. The total number of patient admissions to the ICU during the six-week project implementation period, from August 24th, 2020 to October 4th, was 239. Of those 239 patients, a total of 63 palliative care consultations were received (47 patients from screening and 16 routinely obtained consults). Based on the retrospective chart review, before implementing the screening tool, there was a 12.7% palliative care consultation rate for ICU admissions. Based on the pre-intervention data, at a 12.7% consultation rate, it was expected that there would be 30 palliative care consults for the 239 admitted patients. Data collection revealed a total of 63 palliative care consults with the implementation of the screening tool. The prospective chart review revealed that with the implementation of study intervention, a palliative care screening tool, there was a 26.4% palliative care consultation rate for ICU admissions. A chi-square test was used to calculate statistical significance. There was a statically significant difference between the observed and expected palliative care consults with the implementation of a screening tool. X2 (1) = 41.51, p <.001. Conclusions and implications for practice: In conclusion, the palliative care screening tool is expected to help nurses identify critically ill patients who qualify for a palliative care consult, and palliative care consults are expected to increase. The increase in palliative care consults of patients in the ICU can lead to effective interventions and high-quality care. Based on the anticipated study findings, the palliative care screening tool will be implemented and translated into clinical practice through the adoption of policy change.DNPIncludes bibliographical reference