116\u2005Palliative care provision on the intensive care unit: a service evaluation of identification of need, method of delivery, and quality of care

Abstract

Background 15–20% of critical care patients die during their hospital admission. This service evaluation assesses the quality of palliative care on ICUs compared to national (NICE) standards, and which triggers identify palliative care needs. Methods Retrospective service evaluation, using records review for all patients who died in four ICUs, between 1 June and July 31 2019. Descriptive statistics were reported for patient characteristics, length of stay, admission route, identification triggers, and palliative care delivery. Results N=43. Death was recognised in 88% (38). Among those in which dying was recognized (N=35), 97%(34) had a documented family discussion before death, 9%(3) were offered religious/spiritual support, 11%(4) had review of hydration/nutrition, 6%(2) had documented preferred place of death. Prescription of anticipatory medications was complete in 71%(25) opioids, 34%(12) haloperidol, 54%(19) midazolam, 43%(15) hyoscine. Combining five triggers - length of stay >10 days prior to ICU admission 7%(3), multi-organ 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. 14%(5) were referred to the palliative care team, and 8%(3) had specialist palliative care team review. Conclusions Recognition of dying was high, but occurred close to death. Standard of end of life care was good in terms of family discussion, but religious/spiritual needs, review of hydration/nutrition, and prescription of anticipatory medications were less often considered. The ICUs delivered palliative care using a mainly ‘integrative’ model. Combining five triggers may increase identification of palliative care needs, but a larger study is needed.