Kennedy Aaron C, Jones Daryl A, Eastwood Glenn M, Wellington Duncan, See Emily, Lewis Jane E
ICU Registrar, Intensive Care Unit, Austin Hospital, c/o ICU, 145 Studley Rd, Heidelberg, VIC 3084, Australia.
Intensive Care Unit, Austin Hospital, Heidelberg, VIC, Australia.
Palliat Care Soc Pract. 2022 Oct 15;16:26323524221128838. doi: 10.1177/26323524221128838. eCollection 2022.
Improve documentation quality of end-of-life family meetings in a tertiary intensive care unit (ICU).
Before-and-after interventional quality improvement project between October 2018 and February 2020 utilising an electronic pro-forma record.
Australian, University affiliated, mixed medical-surgical 22 bed adult ICU.
Patients who were admitted to the ICU for active management and subsequently died during that ICU admission. We enrolled 50 patients who died before and 50 patients after the introduction of the electronic family meeting pro-forma record.
Through collaboration with ICU medical and nursing staff, End-of-life Special Interest Group and Clinical Documentation Committee we developed the ICU Family Meeting Discussion Note as an electronic pro-forma record with multiple key fields of entry.
Patient records were examined for the presence of documented details around patient's admission, family meetings and specific elements surrounding the patient's death.
The introduction of a pro-forma record markedly improved the quality of documentation of end-of-life care related family meetings. Documentation increased in recording hospital admission date/time (6% vs 84%), meeting location (14% vs 70%), the reason patients were absent from the meeting (34% vs 72%), the Medical Treatment Decision Maker (MTDM) (10% vs 44%), the patient's resuscitation status (22% vs 54%), and treatment options discussed (78% vs 94%) ( ⩽ 0.005 for all).
Introducing an electronic pro-forma record to facilitate family meeting documentation increased the frequency of important recorded information. Further studies are required to assess whether documentation quality improvements are sustainable and whether they affect patient- or relative-centred outcomes.
提高三级重症监护病房（ICU）临终家庭会议的记录质量。
2018年10月至2020年2月期间采用电子预填记录的前后干预性质量改进项目。
澳大利亚，大学附属医院，拥有22张床位的成人内外科混合ICU。
因积极治疗入住ICU并随后在该次ICU住院期间死亡的患者。我们纳入了引入电子家庭会议预填记录之前死亡的50名患者和之后死亡的50名患者。
通过与ICU医护人员、临终特别兴趣小组和临床记录委员会合作，我们开发了ICU家庭会议讨论记录作为具有多个关键录入字段的电子预填记录。
检查患者记录中是否存在关于患者入院、家庭会议以及患者死亡相关具体要素的记录细节。
引入预填记录显著提高了与临终关怀相关家庭会议的记录质量。记录的医院入院日期/时间（6%对84%）、会议地点（14%对70%）、患者未参加会议的原因（34%对72%）、医疗治疗决策者（MTDM）（10%对44%）、患者的复苏状态（22%对54%）以及讨论的治疗方案（78%对94%）均有所增加（所有对比P⩽0.005）。
引入电子预填记录以促进家庭会议记录增加了重要记录信息的频率。需要进一步研究来评估记录质量的提高是否可持续以及是否会影响以患者或亲属为中心的结果。
