title: Protocolised approach to end-of-life care in the ICU--the ICU PALCare Pilot Project.
abstract: International literature on end-of-life care in intensive care units (ICUs) supports the use of 'protocol bundles', which is not common practice in our 18-bed adult general ICU in Sydney, New South Wales. We conducted a prospective observational study to identify problems related to end-of-life care practices and to determine whether there was a need to develop protocol bundles. Any ICU patient who had 'withdrawal' of life-sustaining treatment to facilitate a comfortable death was eligible. Exclusion criteria included organ donors, unsuitable family dynamics and lack of availability of research staff to obtain family consent. Process-of-care measures were collected using a standardised form. Satisfaction ratings were obtained using de-identified questionnaire surveys given to the healthcare staff shortly after the withdrawal of therapy and to the families 30 days later. Twenty-three patients were enrolled between June 2011 and July 2012. Survey questionnaires were given to 25 family members and 30 healthcare staff, with a high completion rate (24 family members [96%] and 28 staff [93.3%]). Problems identified included poor documentation of family meetings (39%) and symptom management. Emotional/spiritual support was not offered to families (39.1%) or ICU staff (0%). The overall level of end-of-life care was good. The overwhelming majority of families and healthcare staff were highly satisfied with the care provided. Problems identified related to communication documentation and lack of spiritual/emotional support. To address these problems, targeted measures would be more useful than the adoption of protocol bundles. Alternate models of satisfaction surveys may be needed.
authors.affiliation: Intensive Care Unit, Nepean Hospital, Kingswood, New South Wales.
authors.forename: A
authors.initials: A
authors.lastname: Rajamani
authors.affiliation: Intensive Care Unit, Nepean Hospital, Kingswood, New South Wales.
authors.forename: E
authors.initials: E
authors.lastname: Barrett
authors.affiliation: Intensive Care Nursing and Clinical Research Management, Nepean Hospital, Kingswood, New South Wales.
authors.forename: L
authors.initials: L
authors.lastname: Weisbrodt
authors.affiliation: Intensive Care Unit, Nepean Hospital, Kingswood, New South Wales.
authors.forename: J
authors.initials: J
authors.lastname: Bourne
authors.affiliation: Intensive Care Unit, Nepean Hospital, Kingswood, New South Wales.
authors.forename: P
authors.initials: P
authors.lastname: Palejs
authors.affiliation: Intensive Care Unit, Nepean Hospital, Kingswood, New South Wales.
authors.forename: R
authors.initials: R
authors.lastname: Gresham
authors.affiliation: Nepean Hospital, Kingswood, New South Wales.
authors.forename: S
authors.initials: S
authors.lastname: Huang
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D002985:Clinical Protocols; D003142:Communication; D005190:Family / Q000523:psychology; D005260:Female; D019538:Health Care Surveys / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D009517:New South Wales; D010166:Palliative Care / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D010865:Pilot Projects; D011368:Professional-Family Relations; D011446:Prospective Studies; D012944:Social Support; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data
keywords: ICU; end-of-life care