The Institute of Medicine recommends an evidence-based, patient-centered approach to end-of-life care in the U.S. that is evaluated according to a patient perspective framework. Pain and fatigue often limit the dying patient’s ability to participate in discussions about end of life and, as a result, family members are asked to describe the patient’s dying experience. Families have reported dissatisfaction with end-of-life nursing home care related to symptom management, emotional support, and communication with physicians. The purpose of the project was to facilitate an interdisciplinary, evidence-based quality improvement (QI) project with the Performance Improvement (PI) Department and Palliative Care Consult Team (PCCT) related to family satisfaction with end-of-life care in a Midwestern Veterans Administration long term care facility. The goal of the project was to evaluate and improve family satisfaction with end-of-life care at a Midwestern Veterans Administration Medical Center through and evidence based QI project. The objectives of the project included (a) to determine family satisfaction with end-of-life care in 2006, (b) to determine whether family satisfaction with end-of-life care varied according to the nursing home unit where care was provided, (c) to determine if any specific aspects of care, such as respect for the patient and relief of pain had a significant impact on overall satisfaction with care, (d) to determine differences in family satisfaction with end-of-life care from 2004 to 2006, and (e) to develop a QI project related to family satisfaction with end-of-life care, based on annual survey trends. The focus and feasibility of the project were determined in Phase I. Phase II included a review of records to measure family satisfaction with end-of-life care in the facility. Phase III consisted of disseminating the results to the organization, and developing a logic model to evaluate the facility’s pain program and make recommendations for improvement. Phase IV involved the adoption of the proposed pain management program by the administration throughout the facility. Differences in three areas associated with family satisfaction with end-of-life care reached statistical significance over the three year period. The number of families reporting spiritual discussions with staff increased from 2004 to 2006, as did the number reporting that the decedent received care consistent with his/her wishes. More family members, however, identified an unmet need for pain control in 2006 than 2005. The capstone project was presented to the PI Director, PCCT, and staff on the hospice unit. The capstone project was approved for implementation in the facility by the PI Director.
