No CrossRef data available.
Article contents
Effect of a multidisciplinary ward-based intervention on end-of-life care for general medicine patients
Published online by Cambridge University Press: 19 October 2021
Abstract
Objective
Providing good end-of-life (EOL) care for noncancer patients has been made a national priority in Singapore. A combined medical and nursing ward-based intervention known as the EOL care plan was piloted in a general medicine ward at our institution, aiming to guide key aspects of EOL care. The aim of this study is to assess the EOL care plan's effect on EOL care for general medicine patients.
Method
We conducted a retrospective cohort study on inpatients who died in a general ward under the discipline “General Medicine” from May to October 2019. We collected data around symptom management, rationalization of care and communication with families. The primary analysis compared care received by patients who died in the pilot ward with that of a control group of patients who died in other wards.
Results
In total, 112 records were included in the analysis. Pain assessment was more common in the pilot ward compared with the control group (35.3% vs. 6.3%, p < 0.001), as were anti-psychotic prescriptions for delirium (64.7% vs. 24.4%, p = 0.001). Fewer patients received blood glucose monitoring in the last 48 h of life in the pilot ward (69.5% vs. 35.3%, p = 0.007). There were also less frequent parameters monitoring in the pilot ward (p < 0.004).
Significance of results
The implementation of the EOL care plan was associated with process-level indicators of better EOL care, suggesting that it could have a significant positive impact when implemented on a wider scale.
- Type
- Original Article
- Information
- Copyright
- Copyright © The Author(s), 2021. Published by Cambridge University Press
References
REFERENCES
Bailey, FA, Burgio, KL, Woodby, LL, et al. (2005) Improving processes of hospital care during the last hours of life. Archives of Internal Medicine 165(15), 1722–1727.CrossRefGoogle Scholar
Brueckner, T, Schumacher, M and Schneider, N (2009) Palliative care for older people – Exploring the views of doctors and nurses from different fields in Germany. BMC Palliative Care 8(7), 1–11.CrossRefGoogle ScholarPubMed
Bussooa, K and North, E (2016) Personalised care plans in the last days of life. Nursing Times; online issue 9, 7–9.Google Scholar
Clark, K, Curry, T and Byfieldt, N (2015) The effect of a care bundle on nursing staff when caring for the dying. International Journal of Palliative Nursing 21(8), 392–398.CrossRefGoogle ScholarPubMed
Di Leo, S, Beccaro, M, Finelli, S, et al. (2011) Expectations about and impact of the liverpool care pathway for the dying patient in an Italian hospital. Palliative Medicine 25(4), 293–303.CrossRefGoogle Scholar
Farber, SJ, Egnew, TR, Herman-Bertsch, JL, et al. (2003) Issues in end-of-life care: Patient, caregiver, and clinician perceptions. Journal of Palliative Medicine 6(1), 19–31.CrossRefGoogle ScholarPubMed
Finn, L and Malhotra, S (2019) The development of pathways in palliative medicine: Definition, models, cost and quality impact. Healthcare (Basel) 7(1), 22.CrossRefGoogle ScholarPubMed
Gibbins, J, McCoubrie, R, Alexander, N, et al. (2009) Diagnosing dying in the acute hospital setting dare we too late? Clinical Medicine 9, 116–119.CrossRefGoogle Scholar
Gomes, B and Higginson, IJ (2008) Where people die (1974-2030): Past trends, future projections and implications for care. Palliative Medicine 22, 33–41.CrossRefGoogle Scholar
Jackson, K, Mooney, C and Campbell, D (2009) The development and implementation of the pathway for improving the care of the dying in general medical wards. Journal of Internal Medicine 39, 695–699.CrossRefGoogle ScholarPubMed
Koh, M, Yee, A, Yang, G, et al. (2021) SG Pall eBook. Lien Centre for Palliative Care.Google Scholar
Koon, OE, Shan, SN, Shivananda, S, et al. (2015) Use of a modified liverpool care pathway in a tertiary asian hospital: Is there still a role for it? Journal of Palliative Medicine 18(6), 506–512. doi:10.1089/jpm.2014.0343CrossRefGoogle Scholar
Murray, SA, Kendall, M, Boyd, K, et al. (2005) Illness trajectories and palliative care. BMJ 330(7498), 1007–1011.CrossRefGoogle ScholarPubMed
Neo, PS, Poon, MC, Peh, TY, et al. (2012) Improvements in end-of-life care with a protocol-based pathway for cancer patients dying in a Singapore hospital. Annals - Academy of Medicine Singapore 41(11), 483–493.Google Scholar
Neuberger, J, Guthrie, C, Aaronvitch, D, et al. (2013) More care, less pathway: A review of the Liverpool Care Pathway.Google Scholar
Paterson, BC, Duncan, R, Conway, R, et al. (2009) Introduction of the liverpool care pathway for end of life care to emergency medicine. Emergency Medicine Journal 26(11), 777–779.CrossRefGoogle ScholarPubMed
Phillips, J, Halcomb, E and Davidson, P (2011) End-of-life care pathways in acute and hospice care: An integrative review. Journal of Pain and Symptom Management 41(5), 940–955.CrossRefGoogle ScholarPubMed
White, N, Reid, F, Harris, A, et al. (2016) A systematic review of predictions of survival in palliative care: How accurate are clinicians and who are the experts? PLoS One 11(8), 1–11.CrossRefGoogle ScholarPubMed
Soo Rui Ting et al. supplementary material
Soo Rui Ting et al. supplementary material 1
PDF
98.6 KB
Soo Rui Ting et al. supplementary material
Soo Rui Ting et al. supplementary material 2
PDF
567.2 KB