title: Monitoring symptoms in patients with advanced illness in long-term care: A pilot study.
abstract: 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.
authors.affiliation: Terence Cardinal Cooke Health Care Center, New York, New York 10029, USA. jbrechtl@chcsnet.org
authors.forename: John R
authors.initials: JR
authors.lastname: Brechtl
authors.forename: Shaiqua
authors.initials: S
authors.lastname: Murshed
authors.forename: Peter
authors.initials: P
authors.lastname: Homel
authors.forename: Marilyn
authors.initials: M
authors.lastname: Bookbinder
mesh_terms: 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