Development of quality indicators for palliative care in intensive care units and pilot testing them via electronic medical record review

Table 4 Frequency of performance of the measures of processes and outcomes of palliative care in ICU

		General ICU (n = 121)			Emergency ICU (n = 141)			Total (n = 262)
	Indicators	Numerator (n)	Denominator (n)	%	Numerator (n)	Denominator (n)	%	Numerator (n)	Denominator (n)	%
Process
1	Regular pain assessment*	5405	9282	58.2%	2818	8544	33.0%	8223	17826	46.1%
2	Appropriate pain management^†	142	182	78.0%	125	177	70.6%	267	359	74.4%
3	Reassessment of pain after treatment and/or management	73	142	51.4%	41	125	32.8%	114	267	42.7%
4	Regular delirium assessment^‡	3355	4524	74.2%	3379	4218	80.1%	6734	8742	77.0%
5	Assessment of the patient's psychological distress	40	86	46.5%	23	53	43.4%	63	139	45.3%
6	Assessment of social support needs	110	121	90.9%	126	141	89.4%	236	262	90.1%
7	Assessment of the patient's spiritual and cultural practices	7	121	5.8%	6	141	4.3%	13	262	5.0%
8	Identification of the patient's advance directive and ACP for treatment	12	121	9.9%	14	141	9.9%	26	262	9.9%
9	Conduct of an interdisciplinary family conference on palliative care	34	116	29.3%	42	139	30.2%	76	255	29.8%
10	Transmission of key information regarding palliative care following ICU transfer	14	23	60.9%	18	23	78.3%	32	46	69.6%
11	Assessments of psychological distress of family members	49	116	42.2%	59	139	42.4%	108	255	42.4%
12	Documentation of the medical process regarding end-of-life decisions	20	25	80.0%	34	35	97.1%	54	60	90.0%
13	Modification of medical care for it to be in concordance with the goals of care for patients at the end of life	23	25	92.0%	35	35	100.0%	58	60	96.7%
Outcome
14	Patient pain-free in the last 24 h of life	19	19	100.0%	10	23	43.5%	29	42	69.0%
15	Avoid performing CPR when the patient does not want	18	18	100.0%	22	23	95.7%	40	41	97.6%

*Denominator is the number of 4-h patient-nurse intervals (maximum of six per day) during the intensive care unit stay
^†Denominator is the number of 4-h patient-nurse intervals (maximum of six per day) during the intensive care unit stay in which pain was assessed
^‡Denominator is the number of 8-h patient-nurse intervals (maximum of three per day) during the intensive care unit stay

ISSN: 2052-0492