Assessment of implementation of an order protocol for end-of-life symptom management.

Journal of Palliative Medicine
Anne M WallingNeil S Wenger

Abstract

Designing comfort care plans to treat symptoms at the end-of-life in the hospital is challenging. We evaluated the implementation of an inpatient end-of-life symptom management order (ESMO) protocol that guides the use of opiate medications and other modalities to provide palliation. Physicians and nurses caring for patients using the ESMO protocol were surveyed about care provided and their experiences. Over 342 days, 127 patients (2.6 per week) were treated using the ESMO protocol and we surveyed a nurse and/or physician for 105 (83%) patients. Most patients were comatose, obtunded/stuperous, or disoriented when the ESMO protocol was initiated and most had a life expectancy of less than 1 day. One fourth of physicians felt that the protocol was instituted too late, principally citing family unwillingness to reorient toward comfort care. Providers reported that opiates were titrated appropriately, although a minority revealed discomfort with end-of-life opiate use. Nearly all clinicians found the ESMO protocol to be valuable. A standardized protocol is a useful, but not fully sufficient, step toward improving care for dying hospitalized patients.

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Citations

Apr 12, 2016·Journal of Emergency Nursing : JEN : Official Publication of the Emergency Department Nurses Association·Eva RojasMark Rosenberg
Jun 25, 2015·Journal of Palliative Medicine·Katrina J LinRabia S Atayee
Apr 11, 2019·The American Journal of Hospice & Palliative Care·Melissa A BenderLaura Mae-Baldwin
Jan 6, 2019·Healthcare·Marc-Antoine MarquisFrance Gauvin
May 26, 2017·Journal of Palliative Medicine·Melissa A BenderJ Randall Curtis
Sep 25, 2014·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Sheila Nainan MyatraRaj Kumar Mani

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