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Improving the quality of family meeting documentation in the ICU at the end of life

OBJECTIVE: Improve documentation quality of end-of-life family meetings in a tertiary intensive care unit (ICU). DESIGN: Before-and-after interventional quality improvement project between October 2018 and February 2020 utilising an electronic pro-forma record. SETTING: Australian, University affili...

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Autores principales: Kennedy, Aaron C., Jones, Daryl A., Eastwood, Glenn M., Wellington, Duncan, See, Emily, Lewis, Jane E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9577088/
https://www.ncbi.nlm.nih.gov/pubmed/36268273
http://dx.doi.org/10.1177/26323524221128838
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author Kennedy, Aaron C.
Jones, Daryl A.
Eastwood, Glenn M.
Wellington, Duncan
See, Emily
Lewis, Jane E.
author_facet Kennedy, Aaron C.
Jones, Daryl A.
Eastwood, Glenn M.
Wellington, Duncan
See, Emily
Lewis, Jane E.
author_sort Kennedy, Aaron C.
collection PubMed
description OBJECTIVE: Improve documentation quality of end-of-life family meetings in a tertiary intensive care unit (ICU). DESIGN: Before-and-after interventional quality improvement project between October 2018 and February 2020 utilising an electronic pro-forma record. SETTING: Australian, University affiliated, mixed medical-surgical 22 bed adult ICU. PARTICIPANTS: Patients who were admitted to the ICU for active management and subsequently died during that ICU admission. We enrolled 50 patients who died before and 50 patients after the introduction of the electronic family meeting pro-forma record. INTERVENTION: Through collaboration with ICU medical and nursing staff, End-of-life Special Interest Group and Clinical Documentation Committee we developed the ICU Family Meeting Discussion Note as an electronic pro-forma record with multiple key fields of entry. MAIN OUTCOME MEASURES: Patient records were examined for the presence of documented details around patient’s admission, family meetings and specific elements surrounding the patient’s death. RESULTS: The introduction of a pro-forma record markedly improved the quality of documentation of end-of-life care related family meetings. Documentation increased in recording hospital admission date/time (6% vs 84%), meeting location (14% vs 70%), the reason patients were absent from the meeting (34% vs 72%), the Medical Treatment Decision Maker (MTDM) (10% vs 44%), the patient’s resuscitation status (22% vs 54%), and treatment options discussed (78% vs 94%) (p ⩽ 0.005 for all). CONCLUSION: Introducing an electronic pro-forma record to facilitate family meeting documentation increased the frequency of important recorded information. Further studies are required to assess whether documentation quality improvements are sustainable and whether they affect patient- or relative-centred outcomes.
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spelling pubmed-95770882022-10-19 Improving the quality of family meeting documentation in the ICU at the end of life Kennedy, Aaron C. Jones, Daryl A. Eastwood, Glenn M. Wellington, Duncan See, Emily Lewis, Jane E. Palliat Care Soc Pract Original Research OBJECTIVE: Improve documentation quality of end-of-life family meetings in a tertiary intensive care unit (ICU). DESIGN: Before-and-after interventional quality improvement project between October 2018 and February 2020 utilising an electronic pro-forma record. SETTING: Australian, University affiliated, mixed medical-surgical 22 bed adult ICU. PARTICIPANTS: Patients who were admitted to the ICU for active management and subsequently died during that ICU admission. We enrolled 50 patients who died before and 50 patients after the introduction of the electronic family meeting pro-forma record. INTERVENTION: Through collaboration with ICU medical and nursing staff, End-of-life Special Interest Group and Clinical Documentation Committee we developed the ICU Family Meeting Discussion Note as an electronic pro-forma record with multiple key fields of entry. MAIN OUTCOME MEASURES: Patient records were examined for the presence of documented details around patient’s admission, family meetings and specific elements surrounding the patient’s death. RESULTS: The introduction of a pro-forma record markedly improved the quality of documentation of end-of-life care related family meetings. Documentation increased in recording hospital admission date/time (6% vs 84%), meeting location (14% vs 70%), the reason patients were absent from the meeting (34% vs 72%), the Medical Treatment Decision Maker (MTDM) (10% vs 44%), the patient’s resuscitation status (22% vs 54%), and treatment options discussed (78% vs 94%) (p ⩽ 0.005 for all). CONCLUSION: Introducing an electronic pro-forma record to facilitate family meeting documentation increased the frequency of important recorded information. Further studies are required to assess whether documentation quality improvements are sustainable and whether they affect patient- or relative-centred outcomes. SAGE Publications 2022-10-15 /pmc/articles/PMC9577088/ /pubmed/36268273 http://dx.doi.org/10.1177/26323524221128838 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research
Kennedy, Aaron C.
Jones, Daryl A.
Eastwood, Glenn M.
Wellington, Duncan
See, Emily
Lewis, Jane E.
Improving the quality of family meeting documentation in the ICU at the end of life
title Improving the quality of family meeting documentation in the ICU at the end of life
title_full Improving the quality of family meeting documentation in the ICU at the end of life
title_fullStr Improving the quality of family meeting documentation in the ICU at the end of life
title_full_unstemmed Improving the quality of family meeting documentation in the ICU at the end of life
title_short Improving the quality of family meeting documentation in the ICU at the end of life
title_sort improving the quality of family meeting documentation in the icu at the end of life
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9577088/
https://www.ncbi.nlm.nih.gov/pubmed/36268273
http://dx.doi.org/10.1177/26323524221128838
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