Monitoring symptoms in patients with advanced illness in long-term care: A pilot study.
The Edmonton Symptom Assessment Scale (ESAS) was administered daily by nursing staff in a long-term care facility (LTCF) to monitor symptoms. Scores greater than or equal to 5 on a 0-10 scale were considered moderate-to-severe and triggered prompt treatment. One hundred and eight patients with advanced illness and perceived prognosis of less than 6 months were identified for rapid symptom management over a 7-month period. Forty-six (43%) of these patients had at least one episode of moderate-to-severe symptoms during the follow-up period. Thirty-one of these patients (67%) had a primary diagnosis of advanced AIDS and 12 (26%) had advanced cancer. Pain was the most frequent of the 15 symptoms measured, occurring in 29 patients. In the case of pain (P = 0.001), tiredness (P = 0.004), and well-being (P = 0.003), rapid symptom management led to significantly improved distress scores within 48 hours. These data suggest that it is feasible for nurses in an LTCF to use the ESAS on a daily basis to assess patients and obtain prompt treatment for distressful symptoms. Rapid treatment of symptoms can be an important quality indicator in nursing home patients with advanced illness.
Brechtl
John R
JR
Terence Cardinal Cooke Health Care Center, New York, New York 10029, USA. jbrechtl@chcsnet.org
Murshed
Shaiqua
S
Homel
Peter
P
Bookbinder
Marilyn
M
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000451:nursing*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008134:Long-Term Care / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000451:nursing*; D009518:New York / Q000453:epidemiology; D009730:Nursing Assessment / Q000379:methods* / Q000706:statistics & numerical data; D010146:Pain / Q000453:epidemiology / Q000517:prevention & control*; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data; D010865:Pilot Projects; D011785:Quality Assurance, Health Care / Q000379:methods; D013727:Terminal Care / Q000379:methods* / Q000706:statistics & numerical data