Integrating Palliative Care Practices in the ICU

Last Reviewed: March 4, 2019

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.

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Making the Case

Last Updated: February 3, 2019

Rationale and data for integrating palliative care in the ICU.

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

Last Updated: February 3, 2019

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

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

Last Updated: February 3, 2019

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

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Standards for ICU Palliative Care

Last Updated: February 3, 2019

National recommendations and guidelines to improve palliative care in the ICU.

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Integration of Palliative Care in the Context of Rapid Response: A Report From The Improving Palliative Care in the ICU Advisory Board

Last Updated: February 3, 2019

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

Last Updated: February 3, 2019

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

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

Last Updated: February 3, 2019

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

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

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Organizing an ICU-Palliative Care Initiative

Last Updated: February 3, 2019

Practical steps to start a successful, enduring initiative that will improve palliative care for critically ill patients and their families.

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Implementing ICU Screening Criteria for Unmet Palliative Care Needs: A Guide for ICU and Palliative Care Staff

Last Updated: February 3, 2019

Guidance on needs assessment, screening criteria selection, implementation planning, and evaluation.

Primary Palliative Care Trigger Criteria

Last Updated: February 3, 2019

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

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ICU Criteria Grid

Last Updated: February 3, 2019

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

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ICU Palliative Care Service Agreement

Last Updated: February 3, 2019

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

Last Updated: August 11, 2019

Strategies and limitations of prognostication for neurocritically ill patients.

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

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Critical Care Progress Note Template

Last Updated: February 3, 2019

Shared by Northwell Health (formerly North Shore Long Island Jewish).

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Family Conference Progress Note

Last Updated: February 3, 2019

For use by ED staff. Shared by Froedert Hospital, Medical College of Wisconsin.

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The Family Goal-Setting Conference

Last Updated: February 3, 2019

10-step guide including recommended phrases for the clinical team. Shared by Mount Sinai Hospital.

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A Guide for Conducting an ICU Family Meeting When the Patient Is Unable to Participate

Last Updated: February 3, 2019

Communication framework for discussing goals of care with families of patients in the ICU.

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Futility Policy

Last Updated: February 3, 2019

Shared by Froedert Hospital, Medical College of Wisconsin, 2007.

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Guidelines for Use of Pentobarbital for Total Sedation and Ventilator Withdrawal

Last Updated: February 3, 2019

Shared by Froedert Hospital, Medical College of Wisconsin.

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Withdrawal of Mechanical Ventilation Protocol for the Dying Patient

Last Updated: February 3, 2019

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.

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Policy: Screening In the ICU

Last Updated: February 3, 2019

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

Last Updated: August 11, 2019

Strategies and limitations of prognostication for neurocritically ill patients.

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

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Evaluation of ICU Palliative Care Quality

Last Updated: February 3, 2019

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

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Clinician Satisfaction Survey

Last Updated: February 3, 2019

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

ICU Palliative Care Quality Assessment - Physician Survey

Last Updated: February 3, 2019

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

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ICU Palliative Care Quality Assessment - Nurse Survey

Last Updated: February 3, 2019

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

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

Last Updated: February 3, 2019

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

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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

Last Updated: August 16, 2019

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.

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IMPACT-ICU Online Toolkit

Last Updated: February 3, 2019

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.

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

Last Updated: February 28, 2019

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.

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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

Last Updated: January 29, 2019

Information for patients and families about palliative care.

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Palliative Care In the ICU Leaflet

Last Updated: February 3, 2019

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.

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Meeting with the ICU Team: A Guide for Families

Last Updated: February 3, 2019

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.

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Mount Sinai Medical ICU Family Information Brochure

Last Updated: February 3, 2019

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.

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Reference Library

Last Updated: January 29, 2019

Relevant literature for palliative care-ICU integration.

IPAL-ICU

Last Updated: January 29, 2019

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

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Faculty

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