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Palliative Care and the ICU

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Post palliative care consults in the critical care
Author: mherman
Date: Mar 20, 2009 9:33 am
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 frequently in ICU, but the referals come late. Has anyone implementated this model in the ICUs? Any suggestions, guidelines, policies would be appreciated.

Thank you
Marianne
Replies: order by [Date] [Author] [Subject]
+ Re:palliative care consults in the critical care (by Deb on 03/20/2009)
I actually am starting a similar project in concunction with one of the pulmonary critical care physicians in our ICU. He has been doing education with the physicians and I with other staff. We decided to utilize the Norton et al study on proactive ICU consults as the basis and are starting utilizing their criteria for consult. I will round in the ICU and when a pt is id'd who meets criteria, I will leave a letter on the chart for the physician informing them and that palliative care will see within 24 hrs to address goals of care and assist with education and decision-making,unless I hear otherwise, leaving them room to write notes or call me. I am sure I will get some push back from a few docs, but for the most part they are ok with it, so far. That is as close as I can get to automatic referrals at present. The ultimate goal is automatic consults, but we are starting here 1st. The major thing that will contribute to our success in this is the support of the critical care docs and nursing staff.
Re:palliative care consults in the critical care (by SharolHerr on 03/24/2009)
When considering palliative care in the ICU I would recommend that you first look at what your current relationship is with the ICU and then build from there. Looking at the culture in your ICU, your institution and with your physicians can help chart the course for your intervention. There are different models for collaboration and involvement in the ICU that can range from having a collaborative process that leads to development of standardized policies and and protocols to automatic referrals to a trigger system. Where you start will need to reflect where you are in the relationship and current involvement in the ICU's. There is an article that you may find helpful: Campbell ML, Guzman JA. Impact of a proactive approach to improve end-of-life care in a medical ICU. Chest, 2003; 123:266-127.
One of the modules for PCLC II curriculum that has been developed by the Palliative Care Leadership Centers was Palliative Care in the ICU. Contact a PCLC for more information about this learning/training opportunity. It has been established that palliative involvement in the ICU can be a win-win situation for all parties. In this tough economic time and time of potential health care reform the discussion becomes even more relevant. Sharol Herr, RN, MSEd, CHPN, Nurse Clinician/Education Coordinator; Mount Carmel Health Palliative Care Leadership Center; Columbus, Ohio.

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