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Palliative medicine in the intensive care unit: needs, delivery, quality

Hill, Stephanie; Dawood, Abdul; Boland, Elaine; Leahy, Hannah E; Murtagh, Fliss

Authors

Stephanie Hill

Abdul Dawood

Elaine Boland

Hannah E Leahy



Abstract

Background: 15%-20% of critical care patients die during their hospital admission. This service evaluation assesses quality of palliative care in intensive care units (ICUs) compared with national standards. Methods: Retrospective review of records for all patients who died in four ICUs (irrespective of treatment limitation) between 1 June and 31 July 2019. Descriptive statistics reported for patient characteristics, length of stay, admission route, identification triggers and palliative care delivery. Results: Forty-five patients died, two records were untraced, thus N=43. The dying process was recognised in 88% (n=38). Among those where dying was recognised (N=35), 97% (34) had documented family discussion before death, 9% (3) were offered religious/spiritual support, 11% (4) had review of hydration/nutrition and 6% (2) had documented preferred place of death. Prescription of symptom control medications was complete in 71% (25) opioids, 34% (12) haloperidol, 54% (19) midazolam and 43% (15) hyoscine. Combining five triggers - length of stay >10 days prior to ICU admission 7% (3), multiorgan failure ≥3 systems 33% (14), stage IV malignancy 5% (2), post-cardiac arrest 23% (10) and intracerebral haemorrhage requiring mechanical ventilation 12% (5) - identified 60% (26) of patients. Referral to the palliative care team was seen in 14% (5), and 8% (3) had specialist palliative care team review. Conclusions: Recognition of dying was high but occurred close to death. Family discussions were frequent, but religious/spiritual needs, hydration/nutrition and anticipatory medications were less often considered. The ICUs delivered their own palliative care in conjunction with specialist palliative care input. Combining five triggers could increase identification of palliative care needs, but a larger study is needed.

Citation

Hill, S., Dawood, A., Boland, E., Leahy, H. E., & Murtagh, F. (in press). Palliative medicine in the intensive care unit: needs, delivery, quality. BMJ supportive & palliative care, Article 2795. https://doi.org/10.1136/bmjspcare-2020-002795

Journal Article Type Article
Acceptance Date Feb 8, 2021
Online Publication Date Feb 18, 2021
Deposit Date Mar 2, 2021
Publicly Available Date Mar 4, 2021
Journal BMJ Supportive and Palliative Care
Print ISSN 2045-435X
Electronic ISSN 2045-4368
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Article Number 2795
DOI https://doi.org/10.1136/bmjspcare-2020-002795
Keywords Medicine (miscellaneous); Oncology(nursing); Medical–Surgical; General Medicine
Public URL https://hull-repository.worktribe.com/output/3726464
Publisher URL https://spcare.bmj.com/content/early/2021/02/17/bmjspcare-2020-002795