Marché Arnold, DNP, MSN, RN, CPNP-PC

Abstract:

Background: Many professional organizations have recommended early pediatric palliative care involvement for terminally ill children, and it has been shown to improve patient outcomes and quality of life. However, many pediatric intensive care units and providers underutilize this valuable service or delay consultation until the end of life. Objectives: To examine the impact of an educational intervention and implementation of a RN rounding tool and pediatric palliative care screening tool (Pediatric Palliative Screening Scale [PaPaS]) on the rates of palliative care referrals (three months pre- and three months post-intervention). Methods: A pre-and post-design QI project was conducted for registered nurses, nurse practitioners, and medical providers in a 24-bed Pediatric Intensive Care Unit and 6-bed Step-Down Unit at a major academic medical center. Results: The findings showed an increase in overall referrals post-intervention [pre-11 vs. post-16; 45% change] and new referrals [pre-6 vs. post-16; 150% change]. Unit-based referrals demonstrated a 43% increase in PICU referrals and a 50% increase in DOU referrals. There was no significant difference between groups related to age and sex. There was a statistically significant difference in diagnosis between groups with the pre-intervention group predominantly brain (45.5%), cancer (27.3%), and cardiac (18.2%), and the post-intervention group cardiac (33.3%), liver (18.8%) and syndrome (18.8%) acute and chronic conditions (p=.040). Out of the 19 completed PaPaS scales, 14 scores (15-27) indicated the need to initiate a PPC referral. Conclusion: Despite the limited use of the screening tool, there was an increase in new referral patterns, which may have been influenced by the education on palliative care recommendations and the benefit of early referral. With provider workload challenges in many pediatric intensive care units, ongoing educational reminders may be key to keeping early palliative care referrals at the forefront of daily patient care.

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