Table 2 Set of 28 quality indicators for palliative care in ICU
Indicators | Numerator | Denominator | |
|---|---|---|---|
Process | Â | ||
Assessment and management of patient's distress and needs | Â | ||
1 | Regular pain assessment | Number of 4-h periods during the part of the 24-h day that a patient is in the ICU for which pain is assessed and recorded using a quantitative rating scale | Total number of 4-h periods during the part of the 24-h day that the patient is in the ICU* |
2 | Appropriate pain management | Number of records of assessed pain that was treated/managed or reasons why it was not treated/managed | Total number of periods during an ICU stay, in which the patient was assessed as having mild or greater pain (NRS: 4 or greater, BPS: 6 or greater, or CPOT: 3 or greater)** |
3 | Reassessment of pain after treatment and/or management | Number of records of reassessment within at least 2Â h of the treatment/management implemented, whether it was effective or not | Total number of events in which patients admitted to the ICU were treated and managed for pain |
4 | Regular delirium assessment | Number of 8-h periods during the part of the 24-h day that a patient is in the ICU, for which delirium was assessed and recorded using a quantitative rating scale | Total number of 8-h periods during the part of the 24-h day that the patient is in the ICU*** |
5 | Assessment of the patient's psychological distress | Number of patients with records indicating that the patient's psychological distress was assessed | Total number of patients with a GCS of 15 for more than 48 consecutive hours during the ICU stay |
6 | Assessment of public social support needs | Number of patients with records indicating that the need for formal social support for the patient was assessed | Total number of patients in the ICU |
7 | Assessment of the patient's spiritual and cultural practices | Number of patients with records indicating that the patient's spiritual and cultural aspects were assessed | Total number of patients in the ICU |
Patient- and family-centered decision making | Â | ||
8 | Identification of the patient's advance directive and ACP for treatment | Number of patients with records identifying the patient's advance directive for treatment and ACP | Total number of patients in the ICU |
9 | Conduct of an interdisciplinary family conference on palliative care | Number of patients with records indicating that a multidisciplinary conference on palliative care that included the patient or family member was held, and a record of what was discussed | Total number of ICU patients who could identify a family member or a corresponding friend |
Continuity of care | Â | ||
10 | Transmission of key information regarding palliative care following ICU transfer | Number of patients transferred from the ICU with records indicating that information discussed in multidisciplinary conferences on palliative care was passed on to the post-transfer team of health care providers | Total number of patients who were transferred out of the ICU (ex: transferred to another ward or another medical facility) with records indicating that a multidisciplinary conference on palliative care was conducted |
Psychological support for the patient's family | Â | ||
11 | Assessments of psychological distress of family members | Number of patients with records indicating that the patient's family’s psychological distress was assessed | Total number of ICU patients who could identify a family member or a corresponding friend (they have visited) |
End-of-life care | Â | Â | |
12 | Documentation of the medical process regarding end-of-life decisions | Number of patients for whom there is a record of discussion by a multidisciplinary health care team consisting of several physicians, including the primary physician, and other healthcare providers, such as nurses, regarding the determination that the patient is at the end of life | Total number of patients determined to be at the end of life in the ICU |
13 | Modification of medical care for it to be in concordance with the goals of care for patients at the end of life | Number of patients for whom there is a record of a reviewed or changed order that matches the patient's goals of care after the patient was determined to be at the end of life | Total number of patients determined to be at the end of life in the ICU |
Outcome | Â | Â | Â |
End-of-life care | Â | Â | |
14 | Patient pain-free in the last 24Â h of life | Number of patients assessed as having no apparent pain in the 24Â h before death | Total number of patients who died in the ICU |
15 | Avoid performing CPR when the patient does not want | Number of patients for whom CPR was not requested by the patient in the last hour before death | Total number of patients who had a DNAR policy and died in the ICU |
Indicators | Numerator | Denominator | |
Structure | Â | Â | Â |
Setup and availability of resources and care protocols | Â | ||
16 | Use of standardized pain measurement scales | Presence of a policy in the ICU of using quantitative measures to assess pain | ICU |
17 | Use of standardized dyspnea measurement scales | Presence of a policy in the ICU of using quantitative measures to assess dyspnea | ICU |
18 | Use of standardized thirst measurement scales | Presence of a policy in the ICU of using quantitative measures to assess thirst | ICU |
19 | End-of-life-specific symptom management care protocols or order sets | Presence of care protocols or order sets in the ICU for end-of-life-specific symptom management | ICU |
20 | Availability of a palliative care team | Availability of a palliative care team when pain or other physical symptoms are difficult to control | ICU |
21 | Availability of a specialized psychiatric team | Availability of a specialized psychiatric team in presence of delirium, anxiety, or other difficult-to-control psychiatric symptoms | ICU |
Support system for patient's family | Â | Â | |
22 | A flexible visitation policy | A policy that allows for flexible visitation opportunities in accordance with the family's wishes | ICU |
23 | Rooms with privacy for discussions between health care providers and family members | A room with privacy for discussion between healthcare providers and family members is available | ICU |
24 | The system to provide mental health care to patients and their families | Have a system to provide mental health care for patients and their families | ICU |
25 | Leaflet for family members, including information on orientation to the ICU environment and delirium care | Leaflet for family members, including information on orientation to the ICU environment and delirium care | ICU |
26 | The "Critical Care Mediator for Inpatients" is in place in the ICU | A "Critical Care Mediator for Inpatients" is in place in the ICU | ICU |
Support system for ICU staff | Â | Â | |
27 | Regular opportunities for ICU staff to reflect on their end-of-life care experiences to support their emotional well-being | Regular opportunities for ICU staff to reflect on their end-of-life care experiences to support their emotional well-being | ICU |
28 | Access to palliative care specialists and other professionals to discuss ethical issues related to treatment | Access to palliative care specialists and other professionals to discuss ethical issues related to treatment | ICU |