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End of Life Care: Removal of Mechanical Ventilation Algorithm for the Dying Critical Care Patient
Kathleen Hoff MSN, CCRN, FNP-BC
UC Healthcare
February 8, 2012
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Background:
Patients have the right to accept or reject medical treatment
In Critical Care Units as up to 95% of patients may not be able to make decisions known
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Background One in five Americans will die
after receiving care in the critical care area
22% of all deaths in the United States occur in the ICU – many marked with suffering both within physical & emotional domains
www.aacn.org
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Goal of Project Education &
Implementation of End of Life (EOL)
Removal of Mechanical
Ventilation (RMV) Algorithm for the dying critical care
patient
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Methodology: Develop a Strategic Plan & Choose Your Team
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Hypothesis
The development, education and
implementation of End of Life Care:
Removal of Mechanical Ventilation
algorithm will assist the
Interdisciplinary team to provide
essential comfort care when the goal
is to remove the ventilator for the
dying critical care patient
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Why an End of Life Project is Important:
Disparity continues to exist between the actual and the desired state of EOL care in the United States
Awareness, support for, and changes are occurring and needed to make improvements with EOL care
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Key Issue:
End of Life Care (EOL): Removal of Mechanical Ventilation (RMV) Guidelines or Algorithm are not available for critical care teams to assist with comfortable death process
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Project Grid Overview Objective Method/Project Outcome Measurement
Assess: One in five Americans will die after receiving care in the
critical care area
Disparity contuse to exist between the actual & the
desired state of EOL care in the United States
Literature review
MSN research & project
National Recommendations
UCI Expert Opinion
Key Issue: End of Life Care (EOL): Removal of Mechanical
Ventilation (RMV) Guidelines or Algorithm are not
available for Critical Care Interdisciplinary Teams
Development, Education, &
Implementation of EOL RMV
algorithm
Overarching
Goal
Education & Implementation of EOL Care - RMV
Algorithm for the dying critical care patient to help
Interdisciplinary teams provide comfortable death
process
Increase adult & pediatric critical
care nurses knowledge & comfort
of EOL Care –RMV intervention for
the dying critical care patient
Physician & Surgeon education by
poster education
Plan
Implementation
Education: Hot topics & Critical Care unit in-services
Visual Poster Education tool
Algorithm placed on share-drive until order-sets are
complete and entered into Quest
Hot Topics & In-service sign-in
records
EOL –RMV Algorithm will be placed
on Clinical Pathway once order-sets
are in Quest
Education Provide Education as indicated
Monitor EOL-RMV care- education & make
recommendations for best practices
End of Life Education
Education follow up as needed
Post implementation monitoring
Join Nursing palliative care team to
assist in improving end of life care
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Clinical Nurse III Project
Education & Outcome
Measurement Overview/Results
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Project: Education of Clinical Algorithm: End of Life Care Removal of Mechanical Ventilation (RMV)
Hoff, Lekawa,Williams, & Espinosa
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Education Outcome Measurement
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Did yo u re ce ive e d uca tio n o n the re mo va l o f me cha nica l
ve ntila tio n d uring e nd o f l ife ?
Yes
No
Answers Response % Response #
Yes 93.4% 71
No 6.6% 5
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Ha ve yo u ca re d fo r a p a tie nt a t the e nd o f l ife a nd re mo va l o f the
ve ntila to r wa s the p la nne d inte rve ntio n?
Yes
No
Answers Response % Response #
Yes 73.7% 56
No 26.3% 20
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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If yo u a nwse re d ye s to q ue stio n 2, d id yo ur p a tie nt re ce ive a
co mfo rta b le d e a th?
Yes
No
Answers Response % Response #
Yes 96.1% 73
No 3.9% 3
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Do yo u b e lie ve the e nd o f l ife ca re a nd re mo va l o f me cha nica l
ve ntila tio n e d uca tio n will a ss is t in imp ro v ing e nd o f l ife ca re .
Yes
No
Answers Response % Response #
Yes 93.4 71
No 6.6 5
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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CN III Project Objectives
Method/Project Component
Outcome Measurement
Education of EOL: RMV Algorithm
Hot Topics Presentation Critical Care Educational In-services Visual Poster Board of RMV algorithm
Critical care nurses & Interdisciplinary team members received education of RMV algorithm
Post RMV Algorithm education survey sent to all critical care nursing staff
Electronic questionnaire Results from questionnaire
Development of Quest order-set for RMV Ventilator Modes & Medication administration
Use Quest Order-set template
Quest Order-set sub-Committee excepted RMV algorithm order sets
Implementation of RMV Algorithm
Algorithm placed under shared documents
When Quest orders are completed RMV Algorithm will be placed in Clinical Pathways
Completed Measureable Outcomes
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Post CN III Project Reassess Interdisclinpary Team Perceptions of EOL Care after education
Repeat Clinicians' Perceptions of EOL Care using the QOOD ( May or June 2012)
Review of post EOL RMV education & Implementation Propose methodology & results for study for publication
Pre CN III Project Asses Interdisclinpary Team Perceptions of EOL Care after education
Clinicians' Perceptions of EOL Care using the QOOD
Study Implemented October 2011 Results pending
Research Related to Project
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Post CN III Project
Evaluate use of EOL RMV Algorithm
Provide education as needed
Modify RMV Algorithm as needed
Assist Nursing to improve End of Life Care
Mentor a Clinical Nurse II staff nurse with professional advancement to Clinical Nurse III (Continuing with a project related to End of Life)
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Research tells us…When Algorithms
or Guidelines are implemented it is
more likely… EOL care is improved
therefore… Critical Care patients and their families are
provided with comfort, peace and
dignity
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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Thank You… Questions?
NK4f, Kathleen HOff CN III Project End of Life Care Removal of Mechanical Ventilation final presentation to Nursing Quality and Research Council.pdf
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