Document Detail


Assessment of implementation of an order protocol for end-of-life symptom management.
MedLine Citation:
PMID:  18715178     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Anne M Walling; Katherine Brown-Saltzman; Tod Barry; Rita Jue Quan; Neil S Wenger
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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    
Affiliation:
Department of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA 90095, USA. awalling@mednet.ucla.edu
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MeSH Terms
Descriptor/Qualifier:
Analgesics, Opioid / administration & dosage
Attitude of Health Personnel
Attitude to Death
Decision Making
Guideline Adherence*
Humans
Palliative Care / psychology,  standards*
Professional-Patient Relations
Terminal Care / psychology,  standards*
Grant Support
ID/Acronym/Agency:
T32 PE19001/PE/BHP HRSA HHS
Chemical
Reg. No./Substance:
0/Analgesics, Opioid
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