title: Changes in medical and nursing care after admission to palliative care units: a potential method for improving regional palliative care.
abstract: OBJECTIVE
  The purpose of the study was to evaluate changes in medical and nursing care for patients just after admission to a palliative care unit (PCU) from general wards in one city.
  
  
  METHODS
  Subjects were 260 consecutive patients admitted to a PCU. Data on changes in medical and nursing care occurring just after admission were collected prospectively using a structured data collection sheet about four areas: (1) medical treatment, (2) nursing care, (3) giving additional information about the patient's condition to the patient and/or the family, and (4) obtaining psychosocial information.
  
  
  RESULTS
  The mean number of total changes was 8.0 +/- 5.6 per patient. The most common changes in medical treatment were initiation or increase of opioids (18%), discontinuation or decrease in artificial hydration (16%), initiation of steroids (13%), initiation of antiemetics (9%), initiation of antibiotics (8%), and initiation of nonsteroidal anti-inflammatory drugs (7%). The most common changes in nursing care were starting oral care (19%), permission to take a bath (11%), and change in the pattern of meals (8%). Information about the patient's condition was given most frequently to key family members (27%). Psychosocial information obtained most frequently was about the family's expectations regarding the PCU and insight into the patient's condition (53% and 41%, respectively).
  
  
  CONCLUSIONS
  Changes in medical and nursing care were frequent, and the frequency of local healthcare providers' assessment of the changes may be insufficient. Providing general ward staff with data about changes in interventions occurring just after PCU admission might be effective for improving palliative care for terminal patients.
authors.affiliation: The Dia Foundation for Research on Ageing Societies, Bunkyo-ku, Tokyo 113-0033, Japan. igarashi@dia.or.jp
authors.forename: Ayumi
authors.initials: A
authors.lastname: Igarashi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Miyashita
authors.forename: Emi
authors.initials: E
authors.lastname: Kiyohara
authors.forename: Satoshi
authors.initials: S
authors.lastname: Inoue
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009732:Nursing Care; D010166:Palliative Care / Q000458:organization & administration*; D010343:Patient Admission; D010348:Patient Care Team; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires