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Text
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Citation List Month
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URL Address
<a href="http://doi.org/10.1177/0269216313484379" target="_blank" rel="noreferrer">http://doi.org/10.1177/0269216313484379</a>
Dublin Core
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Title
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Impact of a palliative care initiative on end-of-life care in the general wards: A before-and-after study._
Publisher
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Palliative Medicine
Date
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2014
Subject
The topic of the resource
Female; Humans; Male; retrospective studies; Palliative Care; Logistic Models; Aged; Comorbidity; cardiopulmonary resuscitation; Program Evaluation; Social Class; retrospective studies; DNAR; cardiopulmonary resuscitation; Resuscitation Orders; Chronic Disease/therapy; Palliative Care; DNAR Outcomes; Life Support Care/statistics & numerical data; Withholding Treatment/statistics & numerical data; Chronic Disease/epidemiology; Patient Admission/statistics & numerical data; Palliative Care; Hospital Mortality/trends; Advance Care Planning/st [Standards]; Forms and Records Control; Life Support Care/mt [Methods]; Advance Care Planning/standards; Asian; Chronic Disease/ep [Epidemiology]; Chronic Disease/th [Therapy]; Clinical Audit; Do-not-resuscitate orders; Forms and Records Control; general wards; Hospital Mortality/td [Trends]; Life Support Care/methods; Life Support Care/sn [Statistics & Numerical Data]; Patient Admission/statistics & numerical data; Patient Admission/td [Trends]; Patient Admission/trends; Resuscitation Orders; Singapore/ep [Epidemiology]; Singapore/epidemiology; Withholding Treatment/sn [Statistics & Numerical Data]
Creator
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Tan A; Seah A; Chua G; Lim Tow K; Phua J
Description
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BACKGROUND: Data on deaths in the general wards of our hospital in 2007 revealed infrequent discussions on end-of-life care and excessive burdensome interventions., AIM: A physician order form to withhold inappropriate life-sustaining interventions was initiated in 2009. The use of the form was facilitated by staff educational sessions and a palliative care consult service. This study aims to evaluate the impact of these interventions in 2010., DESIGN: Retrospective medical chart review with comparisons was made for the following: baseline patient characteristics, orders concerning life-sustaining therapies, treatment provided in last 24 h of life, and discussion of specific life-sustaining therapies with patients and families., SETTINGS/PARTICIPANTS: This study included all adult patients who died in our hospital's general wards in 2007 (N = 683) versus 2010 (N = 714)., RESULTS: There was an increase in orders to withhold life-sustaining therapies, such as cardiopulmonary resuscitation (66.2%-80.0%). There was a decrease in burdensome interventions such as antibiotics (44.9%-24.9%) and a small increase in palliative treatments such as analgesia (29.1%-36.7%). There were more discussions on the role of cardiopulmonary resuscitation with conversant patients (4.6%-10.2%) and families (56.5%-79.8%) (p-value all < 0.05). On multivariate analysis, the physician order form independently predicted orders to withhold cardiopulmonary resuscitation., CONCLUSIONS: A multifaceted intervention of a physician order form, educational sessions, and palliative care consult service led to an improvement in documentation of end-of-life discussions and was associated with an increase in such discussions and less burdensome treatments. There were small improvements in the proportion of palliative treatments administered.
2014
Identifier
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<a href="http://doi.org/10.1177/0269216313484379" target="_blank" rel="noreferrer">10.1177/0269216313484379</a>
Rights
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2014
Advance Care Planning/st [Standards]
Advance Care Planning/standards
Aged
Asian
Backlog
Cardiopulmonary Resuscitation
Chronic Disease/ep [Epidemiology]
Chronic Disease/epidemiology
Chronic Disease/th [Therapy]
Chronic Disease/therapy
Chua G
Clinical Audit
Comorbidity
DNAR
DNAR Outcomes
Do-not-resuscitate Orders
Female
Forms and Records Control
general wards
Hospital Mortality/td [Trends]
Hospital Mortality/trends
Humans
Journal Article
Life Support Care/methods
Life Support Care/mt [Methods]
Life Support Care/sn [Statistics & Numerical Data]
Life Support Care/statistics & numerical data
Lim Tow K
Logistic Models
Male
Palliative Care
Palliative Medicine
Patient Admission/statistics & numerical data
Patient Admission/td [Trends]
Patient Admission/trends
Phua J
Program Evaluation
Resuscitation Orders
Retrospective Studies
Seah A
Singapore/ep [Epidemiology]
Singapore/epidemiology
Social Class
Tan A
Withholding Treatment/sn [statistics & Numerical Data]
Withholding Treatment/statistics & Numerical Data