Document Detail

Assessment of implementation of an order protocol for end-of-life symptom management.
MedLine Citation:
PMID:  18715178     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: 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.
METHODS: Physicians and nurses caring for patients using the ESMO protocol were surveyed about care provided and their experiences.
RESULTS: 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.
CONCLUSIONS: A standardized protocol is a useful, but not fully sufficient, step toward improving care for dying hospitalized patients.
Anne M Walling; Katherine Brown-Saltzman; Tod Barry; Rita Jue Quan; Neil S Wenger
Related Documents :
18406678 - Estrogenic soybean isoflavones and chronic disease risks and benefits.
10802958 - Attitudes about care at the end of life among clinicians: a quick, reliable, and valid ...
16765848 - Evaluating cam treatment at the end of life: a review of clinical trials for massage an...
20486988 - End of life care.
24271938 - Identifying the supportive care needs of adolescent and young adult survivors of cancer...
24779118 - Developing and executing quality improvement projects (concept, methods, and evaluation).
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of palliative medicine     Volume:  11     ISSN:  1557-7740     ISO Abbreviation:  J Palliat Med     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-08-21     Completed Date:  2008-11-07     Revised Date:  2013-06-05    
Medline Journal Info:
Nlm Unique ID:  9808462     Medline TA:  J Palliat Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  857-65     Citation Subset:  IM    
Department of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA 90095, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Analgesics, Opioid / administration & dosage
Attitude of Health Personnel
Attitude to Death
Decision Making
Guideline Adherence*
Palliative Care / psychology,  standards*
Professional-Patient Relations
Terminal Care / psychology,  standards*
Grant Support
Reg. No./Substance:
0/Analgesics, Opioid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Marital status and health: exploring pre-widowhood.
Next Document:  End-of-life care in U.S. nursing homes: nursing homes with special programs and trained staff for ho...