An interprofessional multicomponent intervention to improve end-of-life care in intensive care: A before-and-after study

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE Australian Critical Care Pub Date : 2024-12-16 DOI:10.1016/j.aucc.2024.101147

Tania Lovell RN, MPH/HM , Marion Mitchell RN, PhD , Madeleine Powell RN, MPH/HM , Petra Strube RN, MN , Angela Tonge BSW, Grad Cert Hlth Studies (Loss & Grief) , Kylie O’Neill RN, MN , Elspeth Dunstan RN, MN , Amity Bonnin-Trickett RN, Grad Cert (Critical Care) , Elizabeth Miller B BEH SC (Hons Psych) , Adam Suliman MB , Tamara Ownsworth PhD , Kristen Ranse RN, PhD

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Abstract

Background

The provision of end-of-life care (EOLC) is an ongoing component of practice in intensive care units (ICUs). Interdisciplinary, multicomponent interventions may enhance the quality of EOLC for patients and the experience of family members and ICU clinicians during this period.

Objectives

This study aimed to assess the impact of a multicomponent intervention on EOLC practices in the ICU and family members' and clinicians’ perceptions of EOLC.

Methods

A before-and-after interventional study design was used. Interventions comprising of EOLC guidelines, environmental and memory-making resources, EOLC education day for nurses, web-based resources, and changes to EOLC documentation processes were implemented in a 30-bed adult tertiary ICU from September 2020 onwards. Data collection included electronic health record audits of care provided post initiation of EOLC and family and clinician surveys. Open-ended survey questions were analysed using content analysis. Data from before and after the intervention were compared using the Chi-squared test for categorical variables, unpaired two-sample t-tests for normally distributed continuous measurements, and Mann–Whitney U tests for non-normally distributed data.

Findings

A reduction in documented observations and medications and an increased removal of invasive devices unrelated to EOLC were observed post the intervention. The mean overall satisfaction of family members improved from 4.5 to 5 (out of 5); however, this was not statistically significant. Statistically significant improvements in clinicians' perception of overall quality of EOLC (mean difference = 0.28, 95% confidence interval: 0.18, 0.37; t₂₈₂ = 5.8, P < 0.01) were found. Although statistically significant improvements were evident in all subscales measured, clinicians’ work stress related to EOLC and support for staff, patients, and their families were identified as needing further improvement.

Conclusions

The development and implementation of a multicomponent interdisciplinary intervention successfully improved EOLC quality, as measured by chart audit and family and clinician perceptions. Continuing interdisciplinary collaboration is needed to drive further change to continue to support high-quality EOLC for patients, families, and clinicians in the ICU.

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改善重症监护临终关怀的跨专业多成分干预：一项前后对比研究。

背景：提供临终关怀（EOLC）是重症监护病房（icu）实践的一个持续组成部分。跨学科、多成分的干预可能会提高患者EOLC的质量，以及家庭成员和ICU临床医生在此期间的经验。目的：本研究旨在评估多组分干预对ICU EOLC实践的影响，以及家庭成员和临床医生对EOLC的看法。方法：采用介入前后对照研究设计。干预措施包括EOLC指南、环境和记忆资源、护士EOLC教育日、网络资源和EOLC文件流程的改变，从2020年9月起在30张床位的成人三级ICU实施。数据收集包括EOLC启动后提供的护理的电子健康记录审计以及家庭和临床医生调查。采用内容分析法对开放式调查问题进行分析。对干预前后的数据进行比较，对分类变量采用卡方检验，对正态分布连续测量采用非配对双样本t检验，对非正态分布数据采用Mann-Whitney U检验。研究结果：干预后观察到记录的观察和药物减少，与EOLC无关的侵入性装置的移除增加。家庭成员的平均整体满意度从4.5分提高到5分（满分5分）；然而，这在统计学上并不显著。临床医生对EOLC整体质量的感知有统计学意义的改善(平均差异= 0.28,95%可信区间：0.18,0.37；结论：多成分跨学科干预的发展和实施成功地提高了EOLC质量，通过图表审计和家庭和临床医生的看法来衡量。需要持续的跨学科合作来推动进一步的变革，以继续支持ICU患者、家属和临床医生的高质量EOLC。

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来源期刊

Australian Critical Care NURSING-NURSING

CiteScore

4.90

自引率

9.10%

发文量

148

审稿时长

>12 weeks

期刊介绍： Australian Critical Care is the official journal of the Australian College of Critical Care Nurses (ACCCN). It is a bi-monthly peer-reviewed journal, providing clinically relevant research, reviews and articles of interest to the critical care community. Australian Critical Care publishes peer-reviewed scholarly papers that report research findings, research-based reviews, discussion papers and commentaries which are of interest to an international readership of critical care practitioners, educators, administrators and researchers. Interprofessional articles are welcomed.