title: Impact of standardized palliative care order set on end-of-life care in a community teaching hospital.
abstract: BACKGROUND
  We evaluated use of medications and interventions in patients receiving a new standardized palliative care order set (PCOS) compared with patients receiving no palliative care orders and those with an order for comfort measures only (CMO), the largely ineffective method used at our institution before implementation of the order set.
  
  
  RESULTS
  We conducted a retrospective chart review of all patients who died at our community teaching hospital between November 2006, 8 months after PCOS implementation, and May 2007. Of 106 patients in the study group, 31 (29%) were treated using the PCOS, 6 (6%) received the CMO order, and 69 (65%) did not receive either. Patients in the PCOS group had significantly more orders for every palliative medication (p ≤ 0.05). Opioids and anxiolytics were made available to every patient in the PCOS group. Most PCOS patients received orders for antiemetic, antipsychotic, antisecretion, and laxative medication during the end-of-life period. No CMO patients and few patients in the no palliative care orders group received orders for these medications. The PCOS and CMO group similarly limited nonpalliative interventions, whereas the nonpalliative group had relatively high use of these interventions until death.
  
  
  CONCLUSIONS
  The palliative care order set implemented at our community teaching hospital significantly improved adherence to accepted palliative care treatment principles for patients at the end of life.
authors.affiliation: Department of Medicine, Union Memorial Hospital , Baltimore, MD 21218, USA. lyn.camire@medstar.net
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Walker
authors.forename: Deanna
authors.initials: D
authors.lastname: Nachreiner
authors.forename: Jaideep
authors.initials: J
authors.lastname: Patel
authors.forename: René L
authors.initials: RL
authors.lastname: Mayo
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Kearney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore; D004358:Drug Therapy / Q000706:statistics & numerical data*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods