Palliative care during the end-of-life period in an intensive care unit - a quality assurance project

This is the authors' abstract. We don't add key points for this paper.

Background:The Norwegian Directorate of Health has issued national clinical guidelines for palliative care during the end-of-life period.Many dying patients in intensive care have a high symptom burden.To ensure that palliative care is of high quality, it is necessary to investigate whether clinical practice is in line with the applicable recommendations. Objective:The objective was to examine documented practice of palliative care during the end-of-life period for patients in an intensive care unit.We also wanted to investigate whether practice was in accordance with the national clinical guidelines. Method:The study is a quality assurance project with a retrospective review of patient medical records.We carried out descriptive, quantitative analyses.The sample consisted of adult patients over the age of 18 who died in an intensive care unit at a university hospital in Norway in 2021.Results: A total of 88 patients died.Of these, 69 were included in the study.The median time between the withdrawal of life-sustaining interventions and death was twelve minutes.There was a documented nursing care plan for the withdrawal of interventions for 13% of the patients.There was no documented pain score for the patients who were conscious.Use of the Critical Care Pain Observation Tool CPOT was documented for 16.7% of the patients who had a decreased level of consciousness, 58.3% of the comatose patients and 44.7% of the sedated patients.None of the patients who were conscious or comatose received a continual infusion of symptom relief medication, only bolus doses.Sedated patients received an infusion of opioids and/or sedatives.There were no documented conversations with the conscious patients.Conversations with patients' families were documented by 94.2% of the doctors and 65.2% of the intensive care unit nurses. Conclusion:The study shows that documentation of pain assessment and nursing care plans for dying patients in intensive care was inadequate.Documentation of information provided to patients was also inadequate.