Palliative Care and End of Life Issues: Palliative Care and End of Life |

Clinical and Educational Benefits of an Electronic End-of-Life Order Set in ICUs FREE TO VIEW

Richard Nunez Lopez, MD; Elaine Chen, MD
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Rush University/Cook County Hospital, Chicago, IL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):948A. doi:10.1016/j.chest.2016.08.1050
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SESSION TITLE: Palliative Care and End of Life

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: End of life care (EOLC) is an important part of patient care in intensive care units (ICUs). Residents’ educational experiences with EOLC vary. The purpose of our study was to evaluate residents’ impressions of the clinical and educational benefits of an electronic EOLC order set in ICUs, designed to improve EOLC.

METHODS: An electronic order set for EOLC in the ICU was developed and implemented by an inter-professional team in a tertiary care center with four adult ICUs. Together with pharmacy and ICU nursing, parameters for titration of opioids and benzodiazepines in this setting were selected. After implementation, focus groups of semi-structured interviews were conducted in each ICU to investigate residents’ learning experiences.

RESULTS: Over a 3-month period, cohorts of residents were approached biweekly in each ICU. A total of 8 focus groups were conducted, with residents in the MICU reporting most use of the order set. Residents expressed an overall positive experience with the ICU EOLC order set. The order set was commonly described as “helpful”, “streamlined” and “very convenient”. A popular characteristic was “having all the medications you need in one place”, particularly when ordering opioid infusions. Residents appreciated the ease of use and thoroughness of content. Subjectively, the order set alleviated distress for staff and expedited administration of medications, which decreased symptoms in dying patients. Almost every group stated “feeling more comfortable managing symptoms at the end of life,” including non-pain symptoms.

CONCLUSIONS: Implementation of an ICU EOLC order set in our institution was qualitatively well received by residents, who described it as easy to use, streamlining the process of ICU EOLC.

CLINICAL IMPLICATIONS: Use of EOLC order sets in the ICU decreases distress amongst clinicians and provides guidance for symptom management. The electronic order set serves as an educational tool for physicians-in-training and provides a reference for medications that may otherwise rarely be used.

DISCLOSURE: The following authors have nothing to disclose: Richard Nunez Lopez, Elaine Chen

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