End of Life Care: Removal of Mechanical Ventilation Algorithm for the Dying Critical Care Patient Kathleen Hoff MSN, CCRN, FNP-BC UC Healthcare February 8, 2012 1
Background: Patients have the right to accept or reject medical treatment In Critical Care Units as up to 95% of patients may not be able to make decisions known 2
Background One in five Americans will die after receiving care in the critical care area 22% of all deaths in the United States occur in the ICU many marked with suffering both within physical & emotional domains www.aacn.org 3
Goal of Project Education & Implementation of End of Life (EOL) Removal of Mechanical Ventilation (RMV) Algorithm for the dying critical care patient 4
Methodology: Develop a Strategic Plan & Choose Your Team 5
Hypothesis The development, education and implementation of End of Life Care: Removal of Mechanical Ventilation algorithm will assist the Interdisciplinary team to provide essential comfort care when the goal is to remove the ventilator for the dying critical care patient 6
Why an End of Life Project is Important: Disparity continues to exist between the actual and the desired state of EOL care in the United States Awareness, support for, and changes are occurring and needed to make improvements with EOL care 7
Key Issue: End of Life Care (EOL): Removal of Mechanical Ventilation (RMV) Guidelines or Algorithm are not available for critical care teams to assist with comfortable death process 8
Project Grid Overview Objective Method/Project Outcome Measurement Assess: One in five Americans will die after receiving care in the critical care area Disparity contuse to exist between the actual & the desired state of EOL care in the United States Literature review MSN research & project National Recommendations UCI Expert Opinion Key Issue: End of Life Care (EOL): Removal of Mechanical Ventilation (RMV) Guidelines or Algorithm are not available for Critical Care Interdisciplinary Teams Development, Education, & Implementation of EOL RMV algorithm Overarching Goal Education & Implementation of EOL Care - RMV Algorithm for the dying critical care patient to help Interdisciplinary teams provide comfortable death process Increase adult & pediatric critical care nurses knowledge & comfort of EOL Care RMV intervention for the dying critical care patient Physician & Surgeon education by poster education Plan Implementation Education: Hot topics & Critical Care unit in-services Visual Poster Education tool Algorithm placed on share-drive until order-sets are complete and entered into Quest Hot Topics & In-service sign-in records EOL RMV Algorithm will be placed on Clinical Pathway once order-sets are in Quest Education Provide Education as indicated Monitor EOL-RMV care- education & make recommendations for best practices End of Life Education Education follow up as needed Post implementation monitoring Join Nursing palliative care team to assist in improving end of life care 9
Clinical Nurse III Project Education & Outcome Measurement Overview/Results 10
Project: Education of Clinical Algorithm: End of Life Care Removal of Mechanical Ventilation (RMV) Hoff, Lekawa,Williams, & Espinosa 11
Education Outcome Measurement 12
Did yo u re ce ive e d uca tio n o n the re mo va l o f me cha nica l ve ntila tio n d uring e nd o f life? Yes No Answers Response % Response # Yes 93.4% 71 No 6.6% 5 13
Have yo u ca re d fo r a p a tie nt a t the e nd o f life a nd re mo va l o f the ve ntila to r wa s the p la nne d inte rve ntio n? Yes No Answers Response % Response # Yes 73.7% 56 No 26.3% 20 14
If yo u a nwse re d ye s to q ue stio n 2, d id yo ur p a tie nt re ce ive a co mfo rta b le d e a th? Yes No Answers Response % Response # Yes 96.1% 73 No 3.9% 3 15
Do yo u b e lie ve the e nd o f life ca re a nd re mo va l o f me cha nica l ve ntila tio n e d uca tio n will a ssist in imp ro ving e nd o f life ca re. Yes No Answers Response % Response # Yes 93.4 71 No 6.6 5 16
Completed Measureable Outcomes CN III Project Objectives Method/Project Component Outcome Measurement Education of EOL: RMV Algorithm Hot Topics Presentation Critical Care Educational Inservices Visual Poster Board of RMV algorithm Critical care nurses & Interdisciplinary team members received education of RMV algorithm Post RMV Algorithm education survey sent to all critical care nursing staff Electronic questionnaire Results from questionnaire Development of Quest order-set for RMV Ventilator Modes & Medication administration Use Quest Order-set template Quest Order-set sub-committee excepted RMV algorithm order sets Implementation of RMV Algorithm Algorithm placed under shared documents When Quest orders are completed RMV Algorithm will be placed in Clinical Pathways 17
Research Related to Project Pre CN III Project Asses Interdisclinpary Team Perceptions of EOL Care after education Post CN III Project Reassess Interdisclinpary Team Perceptions of EOL Care after education Clinicians' Perceptions of EOL Care using the QOOD Repeat Clinicians' Perceptions of EOL Care using the QOOD ( May or June 2012) Study Implemented October 2011 Results pending Review of post EOL RMV education & Implementation Propose methodology & results for study for publication 18
Post CN III Project Evaluate use of EOL RMV Algorithm Provide education as needed Modify RMV Algorithm as needed Assist Nursing to improve End of Life Care Mentor a Clinical Nurse II staff nurse with professional advancement to Clinical Nurse III (Continuing with a project related to End of Life) 19
Research tells us When Algorithms or Guidelines are implemented it is more likely EOL care is improved therefore Critical Care patients and their families are provided with comfort, peace and dignity 20
Thank You Questions? 21