Center to Advance Palliative Care

In the context of palliative sedation on an Acute Palliative Care Unit (APCU) or in a hospice facility, the use of continued monitoring would need to occur within the policies and procedures that are outlined for the facility/organization. The policy previously cited is used within our acute hospital setting and therefore the monitoring guidelines outline care in the ICU as well as use on the Acute Palliative Care Unit (see item "J" in the policy). We have found it necessary to note exceptions to policies that would be appropriate on the APCU within the existing framework for the organization. Therefore, if a patient has an established use of palliative sedation and is then transferred to the APCU the palliative sedation may continue within the guidelines noted in the policy under item "J". Continuous monitoring does not occur on the APCU. That is discontinued when the patient is transferred from the ICU. In our organization, palliative sedation cannot be initiated on the APCU. If exception to the policy is indicated, approval must be given by the physician who leads the Clinical Department Council for the hospital.
We do not have a consent for palliative sedation. It is viewed as other medication protocols used for symptom management. If you are considering palliative sedation for existential reasons that is another discrete issue and would need to be addressed very differently and deliberately in terms of policy, informed consent, etc.
Sharol Herr, RN, MSED, CHPN. Nurse Clinician and Education Coordinator. Mount Carmel Health Palliative Care Leadership Center. Columbus, Ohio.