All ICU patients and their families stand to benefit from palliative care services via referral for consult by the palliative care team and/or delivery of core palliative care services by trained ICU staff. Ideally, these models occur in parallel.

This toolkit was developed and curated by the Advisory Board of IPAL-ICU (Improving Palliative Care in the ICU) in an effort to increase access to palliative care services for patients in the ICU and their families.

What’s in the Toolkit

The "what and the why" of ICU palliative care, including standards for ICU palliative care and how to make the case.

Making the Case
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Rationale and data for integrating palliative care in the ICU.

Palliative Care in the ICU: Pain, Dyspnea, and Thirst

IPAL-ICU report leveraging expertise in critical care and palliative care to address symptom management challenges.

Models for Structuring a Clinical Initiative to Enhance Palliative Care in the ICU

Two models used successfully to integrate and improve palliative care in the ICU.

Standards for ICU Palliative Care
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National recommendations and guidelines to improve palliative care in the ICU.

Integration of Palliative Care in the Context of Rapid Response: A Report From The Improving Palliative Care in the ICU Advisory Board
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How rapid response teams can foster discussions about achievable goals of care and address emergent palliative care needs of patients and families.

Integrating Palliative Care in the Surgical and Trauma Intensive Care Unit

Specific challenges, strategies, and solutions for the surgical intensive care unit.

Palliative Care Processes Embedded in the ICU Workflow May Reserve Palliative Care Teams for Refractory Cases

Exploration of the roles of palliative care and ICU teams in advance care planning.

Practical guidance on model design and tools for identifying patients in the ICU who would benefit from palliative care.

Organizing an ICU-Palliative Care Initiative
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Practical steps to start a successful, enduring initiative that will improve palliative care for critically ill patients and their families.

Implementing ICU Screening Criteria for Unmet Palliative Care Needs: A Guide for ICU and Palliative Care Staff
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Guidance on needs assessment, screening criteria selection, implementation planning, and evaluation.

Primary Palliative Care Trigger Criteria

CAPC consensus report for identification of patients with palliative care need. 2011.

ICU Criteria Grid
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Sample palliative care screening tool for ICU patients. Shared by Mount Carmel Health.

ICU Palliative Care Service Agreement
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Sample agreement between palliative care and ICU teams defining palliative care referral criteria, palliative care scope of practice for ICU patients, and communication protocols between clinical teams. Shared by the John D. Dingell VA Medical Center.

Palliative Care in the Neuro-ICU: The Crystal Ball of Prognosis

Strategies and limitations of prognostication for neurocritically ill patients.

Tools for both palliative care and ICU teams to assess need, conduct family meetings about priorities for care, and provide services in the ICU.

Critical Care Progress Note Template
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Shared by Northwell Health (formerly North Shore Long Island Jewish).

Family Conference Progress Note
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For use by ED staff. Shared by Froedert Hospital, Medical College of Wisconsin.

The Family Goal-Setting Conference
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10-step guide including recommended phrases for the clinical team. Shared by Mount Sinai Hospital.

A Guide for Conducting an ICU Family Meeting When the Patient Is Unable to Participate
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Communication framework for discussing goals of care with families of patients in the ICU.

Removal of Mechanical Ventilation
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Shared by Froedert Hospital, Medical College of Wisconsin, 2007.

Withdrawal of Mechanical Ventilation Protocol for the Dying Patient
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A compassionate process for removing mechanical ventilation (RMV) in the dying patient. To be used when death is the expected outcome following RMV. Shared by Froedert Hospital.

Policy: Screening In the ICU
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Sample policy for palliative screening and assessment by ICU staff. Shared by Mount Carmel Health.

Palliative Care in the Neuro-ICU: The Crystal Ball of Prognosis

Strategies and limitations of prognostication for neurocritically ill patients.

Measurement strategies to evaluate patient, family, and clinician satisfaction with services, in support of ongoing quality improvement.

Evaluation of ICU Palliative Care Quality
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Quality measures for palliative care in ICU settings, and using measurement to guide QI.

Clinician Satisfaction Survey
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Assess referrer satisfaction with palliative care. Shared by the VA Ann Arbor Healthcare System.

ICU Palliative Care Quality Assessment - Physician Survey

Assess ICU physician satisfaction with palliative care. Shared by the University of Washington School of Medicine.

ICU Palliative Care Quality Assessment - Nurse Survey

Assess ICU nursing satisfaction with palliative care. Shared by the University of Washington School of Medicine.

National Palliative Care Research Center (NPCRC) Measurement and Evaluation Tools

NPCRC provides measurement and evaluation tools for research, including pain and symptom management, functional status, psychosocial care, caregiver assessment, and quality of life.

Training ICU teams in communication skills and family caregiver support, including CAPC’s online CE curriculum on communication skills for clinicians from all disciplines.

Online Clinical Training Courses For All Clinicians

Online training curriculum for all specialties and disciplines to strengthen their care of patients living with serious illness. Free continuing education credits for all, and physicians receive ABIM MOC points for select courses.

IMPACT-ICU Online Toolkit

IMPACT-ICU (Integrating Multidisciplinary Palliative Care into the ICU) is a quality improvement and professional development program to integrate palliative care into the ICU by training and supporting bedside nurses. The free online toolkit includes videos that illustrate the crucial roles of bedside nurses in ICU palliative care and serious illness communication. Downloadable and printable guides facilitate use of the videos for self-study, education sessions, and as part of institutional improvement projects.

End-of-Life Nursing Education Consortium - Critical Care Train-the-Trainer Courses (ELNEC)

A train-the-trainer program, held once or twice annually at a specific location, covering eight curriculum modules. Participants receive up-to-date resources for teaching at their home institutions.

Online information and sample materials developed by ICUs nationwide to explain the role and benefits of palliative care to patients and families.

Get Palliative Care

Information for patients and families about palliative care.

Palliative Care In the ICU Leaflet
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Sample handout used to explain the role and function of the palliative care team to ICU patients and their families. Shared by Mount Carmel Health.

Meeting with the ICU Team: A Guide for Families
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Guide to help families prepare for a meeting with the clinical team. The intent is to make ICU family meetings more effective and efficient. Developed by Veterans Integrated Service Network 3.

Mount Sinai Medical ICU Family Information Brochure
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Handout based on a 2002 RCT showing that a family information leaflet was associated with greater comprehension and satisfaction among ICU families

Relevant publications for integrating palliative care in the ICU.

Reference Library
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Relevant literature for palliative care-ICU integration.

IPAL-ICU

Members of CAPC's IPAL-ICU Advisory Council, which co-authored many of the resources in this toolkit.

Faculty