McCarroll Caitlin Marie
Caitlin Marie McCarroll, DNP, APRN, FNP-BC, obtained her BSN from the University of South Carolina, Columbia, and her DNP from the Medical University of South Carolina, Charleston. She is a member of Sigma Theta Tau International Honor Society of Nursing and the American Association of Nurse Practitioners. She also serves as a board member for Capitol Nurse Practitioner Group in Columbia, South Carolina. She is currently employed as a nurse practitioner providing both inpatient and outpatient palliative care.
Dimens Crit Care Nurs. 2018 May/Jun;37(3):180-192. doi: 10.1097/DCC.0000000000000299.
The Institute of Medicine's report, Dying in America, highlights the critical need for the widespread implementation of palliative care to improve end-of-life care. Approximately 20% of all deaths in America occur during or shortly after an intensive care unit (ICU) admission; therefore, it is important for critical care units to have systems in place to facilitate patient access to palliative care services.
The aim of this quality improvement (QI) project was to develop and implement a palliative care screening tool using evidence-based triggers to help increase the proportion of palliative care consultations in the ICU setting.
A QI project was designed and implemented in a 14-bed medical-surgical ICU in the southeastern United States using the Plan-Do-Study-Act cycle. A palliative care screening tool was developed by an interdisciplinary team of key stakeholders in the ICU using evidence-based triggers, and staff were educated on the intervention. The proportion of ICU patients who received a palliative care consultation was compared preintervention and postintervention to determine whether the QI project contributed to an increased proportion of palliative care consultations.
The proportion of palliative care consultations among patients admitted to the ICU by the pulmonary critical care team increased from 1 of 10 preintervention to 3 of 10 postintervention, resulting in a promising increase in patients receiving palliative care services consistent with evidence-based recommendations.
The use of an evidence-based screening tool to trigger palliative care consultation in the ICU setting can aid in increasing the proportion of critical care patients who receive a palliative care referral. The increase in the proportion of palliative care referrals by the pulmonary critical care service warrants expansion of the intervention to include additional medical subspecialists who frequently admit patients in this ICU setting. Further assessment of the intervention is warranted to determine whether the screening tool can aid in increasing palliative care consultations for more patients admitted to the hospital's ICU.
美国医学研究所的报告《美国的死亡》强调了广泛实施姑息治疗以改善临终护理的迫切需求。在美国，约20%的死亡发生在重症监护病房（ICU）住院期间或之后不久；因此，重症监护病房建立相应系统以方便患者获得姑息治疗服务很重要。
本质量改进（QI）项目的目的是开发并实施一种基于循证触发因素的姑息治疗筛查工具，以帮助提高ICU环境中姑息治疗会诊的比例。
在美国东南部一家拥有14张床位的内科-外科ICU中，采用计划-实施-研究-改进循环设计并实施了一项QI项目。一个由ICU关键利益相关者组成的跨学科团队利用循证触发因素开发了一种姑息治疗筛查工具，并对工作人员进行了干预培训。比较干预前后接受姑息治疗会诊的ICU患者比例，以确定QI项目是否有助于提高姑息治疗会诊的比例。
肺部重症监护团队收治的ICU患者中，姑息治疗会诊的比例从干预前的十分之一增加到干预后的十分之三，这使得接受姑息治疗服务的患者数量有望增加，且符合循证建议。
在ICU环境中使用基于循证的筛查工具来触发姑息治疗会诊，有助于提高接受姑息治疗转诊的重症监护患者的比例。肺部重症监护服务中姑息治疗转诊比例的增加，值得扩大干预范围，将经常收治该ICU患者的其他医学亚专科纳入其中。有必要对该干预措施进行进一步评估，以确定筛查工具是否有助于为更多入住医院ICU的患者增加姑息治疗会诊。
