Problem: Patients in the intensive care unit (ICU) hang in a delicate balance between life and death and this uncertainty creates anguish for patients and families. They need information, guidance and support as they try to navigate the course of a critical illness; however, studies indicate these needs are not met. The primary recommendation for meeting these needs is integrating palliative care (PC) into the comprehensive care of critically ill patient. Although Clinical Practice Guidelines (CPGs) were developed to help facilitate this integration, gaps in adherence to the CPG were identified within a selected health care organization. Purpose: The primary purpose of this capstone project was to evaluate the provision of evidence-based PC to critically ill patients by assessing the level of adherence to CPGs. A secondary purpose was to promote evidence-based practice by identifying strategies and developing interventions to enhance the provision of evidence-based PC in ICU. Goal: The goal of this project was to identify and implement an evidence-based practice change that would improve the provision of PC to critically ill patients. Objectives: First, determine current state of PC provision in the ICU. Second, locate and analyze the best evidence regarding the provision of PC to critically ill patients. Third, design interventions and develop strategies that supported the provision of evidence-based PC in the ICU. Fourth, implement and evaluate the effectiveness of the practice change on improving the provision of evidence-based PC. Fifth, integrate PC into the comprehensive care of all critically ill patients as standard practice and set a measurement for ongoing monitoring. Plan: This project was an evidence-based practice change and the plan consisted of five phases, which mirrored the five aforementioned objectives. The plan engaged key stakeholders throughout the process. Outcomes and Results: Key findings revealed an improvement in the adherence to CPGs for PC and reduction in resource utilization. Baseline CPG adherence rate was calculated at 59% and increased to 73% after the implementation of the practice change. Additionally, practice changes that improved the provision of PC care to the imminently dying patient were directly associated with a decrease in resource utilization and included a reduction in ICU length of stay by 0.8 days; a reduction in direct costs by $4200; and a cost avoidance of $2.5 million.
