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CAPCconnect™ palliative care discussion forum

Palliative Care and the ICU


Number of threads on this Forum: 42
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Subject Author Posts Last Post
Description
Post Partial DNR's Deb 2 01/25/2012
Hi, My group of intensivists are finally getting fed up with partial DNR orders, like chemical code only. There are only a few physicians still writing this and these are usually the physicians who resist allowing palliative care involvement too, so I hav ...
Post ICU LOS akrause 5 10/28/2011
Two questions: Does anyone have data on how much a proactive palliative care consult impacts a PC service LOS? Hospital administrators are looking at the total LOS but if PC gets involved on HD #2, after a positive palliative care screen, our LOS increas ...
Post subcutaneous catheter policies ultrapollo08 1 08/29/2011
We are beginning to provide more acute palliative care to our patients and would like to adopt a subcutaneous catheter infusion policy. I have a sample for our local hospice but was wondering if someonw could share this policy with me. I am challenged to ...
Post ICU/PC Representation on Ethics Committees HilliardB 7 12/02/2011
Looking for information on ICU or palliative care representation on the institution's ethics committee. If your hospital has an "active and effective" committee, does anyone from ICU or the palliative care service serve as a member?
Post Written Consent to withhold withdraw life support ultrapollo08 2 08/24/2011
In Nevada we have a law that requires written consent to withhold or withdraw life support. Can someone share with me the laws governing this in the state they practice in? I am working with legislation to change this to implied consent NRS 449.626 ...
Post Palliative Care in CCU HilliardB 2 08/08/2011
One way to increase requests for PC consults is to ask for help from the hospital's ethics committee. Ethics committees have a variety of strategies and ideas for instituting "culture change" and helping physicians and families see the value of PC.
Post pt in denial and upset about talking about illness maryg 3 08/04/2011
elderly female with lung cancer and in ICU with sob referal to discuss goals of care. When I spoke with patient she stated she could never discuss if she would want to stop aggressive therapy. I agreed I would not bring up again since was upsetting. Went ...
Post ICU palliative care barriers in nursing care ICU_nurse 4 06/20/2011
Working in the medical ICU, I still do not see enough palliative care consults (and we have a wonderful palliative care team in the hospital). How does one initiate a "culture change?"
Post CRRT ultrapollo08 5 04/22/2011
I am looking for a standard to base the need to initiate CRRT in the ICU. Does anybody use the APACHE II scoring system and predictor of outcomes? If so at what score triggers a case conference or do you require them of all cases prior to starting CRRT?
Post automatic referasl in ICU maryg 2 03/11/2011
I was just apporoached by our Citical Care Medical Director that he would like me to develope of propossl on automatic referals for PC in the ICU. Love the idea but feel a little overwhelmed with the task and where to start. Anyone have any suggestions?
Post DOH: Palliative Care Information ACT New York Stat Laura 2 03/14/2011
The palliative care information act just became law in NY state on 2/9/11 requiring attending physicians and NPs to offer "terminally ill" (defined as having a condition likely to cause death within 6 months) patients counseling and information regarding ...
Post Who can initiate a DNR/Treatment limitation order? jgoodill 2 02/11/2011
I am a palliative care physician and have been involved in designing our DNR order form/policy. currently we allow residents to initiate a DNR as long as the attending signs it within 24 hrs. more recently we have allowed APN/Pas to do the same. How do ...
Post Palliative Performance Score use in ICU setting jward10450 2 02/09/2011
We have just starting a pilot tracking PPS in our inpatient consultation service with the hope to tie scores to survival data and benchmark against some of the published works using this tool in the cancer population. Obviously this does not translate we ...
Post 3 New Tools Posted on IPAL-ICU! PCaines 1 01/03/2011
Dear Forum Community: I want to alert you about following 3 new tools posted to our IPAL-ICU website: 1 -- Clinician Satisfaction Survey (Ann Arbor VA) as posted under the section entitled, "Quality Monitoring Tools" 2 -- ICU Pall Care Service Ag ...
Post organ donation for terminal extubation patients s2white 2 12/09/2010
Our Palliative Care Service is involved in some but not all terminal weans in the ICU's. Up to now, Spiritual Care has discussed organ donation with the families. We do have a chaplain on our team, but he does not feel comfortable or competent to discuss ...
Post Heart Transplant and LVAD patients cblizzard 3 12/07/2010
Does anyone have experience in working with heart transplant and LVAD teams?
Post Getting hospital financial support mjsearcy 3 10/28/2010
I am a palliative care physcian who works full time in the intensive care units (80 bed) at the largest private hospital(>600 beds) in our state. I have focused on terminal extubations for the last two years (250 deaths since 2008). I attend each death, ...
Post family meeting template doclake 2 10/26/2010
We are instituting the palliative care "bundle" in our ICU. Part of the bundle is the family meeting by day 5. I am looking for a template that may be used by teams (both palliative and primary team) to document that the necessary topics were covered, who ...
Post Futile care maryg 4 09/03/2010
I am looking for hospital policy on Futile care does anybody have one. mary.l.garrison@osfhealthcare.org
Post Triggers ceaelle 3 06/18/2010
Can you give some specific examples that should trigger a palliative care referral from the ICU? If we used a nursing-based model for screening measures, how many triggers should we use? If this is done on admission to ICU, if and when should follow-up oc ...
Post Palliative care contracts Laurie_M 2 05/06/2010
We are just getting started with our inpatient palliative care program. We will see the patients in the hospital and then plan to continue to follow patients for palliative care after they leave the hospital. Do patients have to sign a contract with us fo ...
Post ICU patient survey leslie1214 2 05/11/2010
Does anyone use a patient satisfaction survey to evaluate their EOL care during their stay in the ICU? If so, would you be willing to share?
Post ICU and Hospice LibbyT 3 03/23/2010
Hi - I am new to this forum. We have a well-established palliative care service in a large metropolitian hospital in Houston. We are very active in our ICUs and have a proactive palliative care pilot program to reduce death in the ICU underway. We have in ...
Post Goals of Care Bcabil 1 01/31/2010
"Quality palliative and end-of-life care in the ICU is an ethical imperative. Initiating early discussion about patient preferences and palliative needs and structured daily reassessment is an approach that promotes excellent palliative care simultaneousl ...
Post Cutting Costs! cnalls 2 01/31/2010
"Hospital palliative care programs have been shown to improve physical and psychological symptom management, caregiver well-being, and family satisfaction, and small, single-site studies suggest that palliative care programs may reduce hospital and intens ...
Post Improvement needed? chrmcbride 2 01/30/2010
Death occurrence,58% in hospitals, 22% at home, 20% nursing homes, 59% of all hospital deaths occur in ICUs, 540,000 decedents a year according to (Weitzen et al, 2003; Angus et al, 2004) With these types of numbers it is imperative that ICU nurses and P ...
Post Fentanyl Drip Protocol CMichael 2 10/12/2009
Hello All, I'm new to this discussion group and apologize in advance if this topic has been posted before. We are in the process of developing a Fentanyl Drip protocol for use in pain management as well as palliative care. Does anyone have a protocol t ...
Post Triggers for MICU ginat 2 08/26/2009
Does anyone use triggers to determine what patients will have a Palliative care consult?
Post Use of Fentanyl and Versed drips in withdrawal pstark 4 06/18/2009
In the case of compassionate extubation, what role (if any) does the use of fentanyl and versed drips play? Particularly, the question of the drips being assistive with the suppression of the respiratory drive rather than for comfort measures? Just looki ...
Post palliative care consults in the critical care mherman 3 03/24/2009
I have been asked by the Dept. of critical care Chair to expand our program to include palliative care as the standard of care ( best practices). The palliative care will be an automatic referal vs consult from providers. Currently I am consulted frequent ...
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