The Use of a Palliative Care Screening Tool in the Intensive Care Unit

Background: Patients with an abrupt life altering event or chronic illness are admitted to the intensive care unit (ICU) and frequently are at the end of life (EOL). Most often, these patients have not established or discussed their quality of life wishes at the EOL with their families or healthcare providers. This creates uncertainty and stress for the patients’ loved ones, and ethical issues of patient pain and suffering while enduring futile lifesaving interventions.

Purpose: Address unmet patient pain, suffering, and right to autonomy needs; while fulfilling nursing standards of the Code of Ethics, nonmaleficence, beneficence, and respect in order to provide, implement quality of care, and prevent healthcare provider moral distress at the EOL.

Theoretical Framework: Orem Self Care, American Association of Critical Care Nurse Synergy Model, Self-determination Theory, Code of Ethics.

Methods: Utilization of an ICU palliative care screening tool to identify unmet patient needs at the EOL in the ICU.

Result: A retrospective analysis of patients who died in the ICU equaled an average length of stay (LOS) of 8.14 days, which is greater than the national LOS of 3.6 days. Application of the screening tool identified many patients with multiple categories of unmet patient needs and ethical dilemmas.

Conclusion and Implications: Utilizing a dedicated ICU screening tool can identify and support the need to address holistic and ethical issues, prevent and relieve pain and suffering and promote quality of life at the EOL in the ICU.

Keywords: Palliative care; Critical care; EOL; Policy; Ethics