Improving Palliative Care Management in the Nursing Home Setting: An Interprofessional Approach
Date of Publication
Mary Val Palumbo, DNP and Sarah Hutchins, RN
Purpose: Current projections indicate that the number of individuals age 65 and older throughout the U.S. will reach nearly 88 million by 2050, nearly double current estimates. With the increase in older adults, an increase in persons with chronic illness requiring nursing home care is also sure to rise. Currently, roughly 1.4 million adults reside in certified nursing facilities throughout the U.S. while nearly 25% of older adults die within this setting. Palliative care, an approach aimed at improving the quality of life of patients facing life-threatening illness is one strategy utilized to help manage this population. As the quality of life of nursing home residents often decreases in their last year of life, an effort to improve palliative care services within this setting appears warranted. Recommendations by the American Nurses Association advocate for the use of the National Consensus Project for Quality Palliative Care’s Clinical Practice Guidelines for Quality Palliative Care (2013) in the development and implementation of all palliative care services. These guidelines emphasize an interprofessional approach to patient management encompassing eight palliative care domains. The purpose of this project was to develop a palliative care program based on these guidelines to be utilized within the nursing home setting. The program was comprised of a newly developed palliative care protocol to be used by nursing staff in conjunction with the formation of an in-facility interprofessional palliative care team with the purpose of working with the nursing staff to provide care to these residents.
Methods: A needs assessment including literature review, resident chart review, nursing staff survey and stakeholder interviews was performed within a nursing home encompassing skilled-nursing and long-term care services. The chart review examined residents who passed away within the last twelve months (n=21) focusing on clinical measures based on the eight palliative care domains outlined in the NCP’s guidelines. Staff survey and stakeholder interviews were utilized to gain insight into staff understanding and ability to provide palliative care services, as well as to obtain buy-in on the establishment of the interprofessional palliative care team. Following the needs assessment, a facility-wide palliative care protocol was created, presented to and accepted by the facility’s administration. Nursing staff training regarding the protocol and the utilization of the interprofessional team were provided.
Results: The chart audit revealed gaps in palliative care services in the domains of physical, social, cultural, spiritual and end-of-life care. Survey results indicated a lack of consistency with providing palliative care while staff expressed a desire for more palliative care resources and a willingness to work as an interprofessional team. Results indicate that the interprofessional team met regularly to manage residents approximately once per month. A retrospective chart review of those residents who passed away during implementation was performed and showed improvement in regards to hospice referrals and out-of-facility transfers.
Conclusion: Despite current best practice guidelines, gaps in palliative care within the nursing home setting exist. The development of a palliative care program consisting of staff resources and an interprofessional team to improve care for resident’s at the end-of-life was needed and well-received by administration and staff. Outcome measurement and quality assurance can be ongoing with the chart audit tool which was created.
Fredette, Nicholas Adam, "Improving Palliative Care Management in the Nursing Home Setting: An Interprofessional Approach" (2018). College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications. 14.