title: Facilitating palliative care referrals in the intensive care unit: a pilot project.
abstract: BACKGROUND
  Palliative care in intensive care units (ICUs) reduces costs and improves outcomes yet is consistently underused; studies suggest that screening tools increase the use of palliative services.
  
  
  OBJECTIVE
  This project piloted the use of the Palliative Performance Scale, version 2 (PPSv2), as a trigger for palliative care referrals in a 12-bed medical ICU.
  
  
  METHODS
  Using a preintervention-postintervention design, the authors measured the effect of the intervention on nurses' comfort and knowledge in assessing palliative care needs, number of palliative care referrals, and number of days between ICU admission and palliative care referral. The authors also measured uptake of the scale over 12 weeks of implementation and asked nurses to share their thoughts about using the PPSv2.
  
  
  RESULTS
  Over 610 observations, the rate of uptake increased over time and use of the scale ranged from 24.2% to 85.6%. The nurses' (n = 26) comfort with palliative care issues increased from preintervention to postintervention, albeit not significantly. Knowledge items did not change. There was a 110% increase in the number of palliative care referrals between preintervention and postintervention and a nearly 1-day decrease in the number of days between medical ICU admission and palliative care referral; this reduction was not statistically significant. A majority of nurses (n = 22 [84.5%]) voted to retain the PPSv2 as an official process of care, stating that the tool facilitated assessment of patient needs that might have been previously overlooked.
  
  
  CONCLUSIONS
  Data suggest that the PPSv2 was well received by the bedside nurses and changed practice patterns with regard to facilitating palliative care services.
authors.affiliation: Mimi Jenko, DNP, RN, CHPN, PMHCNS-BC, is an professor of Polk State College Department of Nursing, Winter Haven, Florida. Her clinical interest is palliative care, with a specialty in bereavement. Judith A. Adams, PhD, MSN, RN, FNP, is visiting assistant professor at the School of Nursing, University of North Carolina at Greensboro. Dr Adams worked as a nurse practitioner in hospice and palliative care; her research focuses on palliative care and nursing communication in the intensive care unit. Constance M. Johnson, PhD, MS, RN, FAAN, is an associate professor and a health informaticist with interdisciplinary training in nursing and health informatics and is lead faculty for the Informatics Specialty at the Duke University School of Nursing. Dr Johnson's research interests include human-computer interaction and how presentation of information impacts health-related decisions in the areas of cancer prevention and diabetes. Julie A. Thompson, PhD, is a consulting associate, Duke University School of Nursing; she is a content expert for statistics. Donald E. Bailey Jr, PhD, RN, FAAN, is an associate professor in the Duke University School of Nursing, senior fellow in the Duke Center for the Study of Aging and Human Development, and Claire M. Fagin Fellow. His research interests include aging and chronic illness, men's health, and psychooncology.
authors.forename: Mimi
authors.initials: M
authors.lastname: Jenko
authors.forename: Judith A
authors.initials: JA
authors.lastname: Adams
authors.forename: Constance M
authors.initials: CM
authors.lastname: Johnson
authors.forename: Julie A
authors.initials: JA
authors.lastname: Thompson
authors.forename: Donald E
authors.initials: DE
authors.lastname: Bailey
mesh_terms: D003422:Critical Care / Q000592:standards*; D006801:Humans; D007318:Inservice Training; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards; D009741:Nursing Staff, Hospital; D010166:Palliative Care / Q000592:standards* / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration*; D010865:Pilot Projects; D012017:Referral and Consultation