'But I Can’t Let Him Starve!' A Comprehensive Palliative Approach to the Assessment and Management of Anorexia (TH326)

Autor: Mary K. Buss, Lauren Fay, Victoria Gurfolino, Kathleen Rimer
Rok vydání: 2016
Předmět:
Zdroj: Journal of Pain and Symptom Management. 51:328
ISSN: 0885-3924
DOI: 10.1016/j.jpainsymman.2015.12.150
Popis: List common concerns and complications that occur using these order sets related to rapid titration of infusions. Describe an updated, evidence-based comfort care order set for withdrawal of life sustaining therapies including provider decision tools, treatment algorithms, electronic ordering design and educational dissemination. Pain, dyspnea, and other symptoms are common in lifelimiting illness, particularly in the last weeks of life. Uncontrolled symptoms at the end of life cause distress and compromise quality of life for patients and families. Clinicians also experience distress while caring for these patients. Similar to previously published standardized approaches, our old comfort care order sets were based on historical protocols for sedation and analgesia, which allowed for frequent increases in intravenous opioid continuous infusions to manage symptoms. Clinically, we have seen rapidly increasing opioid doses cause toxicity, discomfort, and moral distress. We have also seen wide variability in practice in the application of these order sets among providers and nurses. A 2013 Cochrane Review recommended that institutions audit their end-of-life pathways, citing a lack of new studies and safety concerns with current pathways. For these reasons, we sought to revise our comfort care order set with a goal to provide better symptom management for patients receiving comfortfocused care at the endof life and to providemore guidance for clinicians involved in treating these symptoms. We will describe the historical development and current literatureof comfort careorder sets to illustrate common challenges and concerns with their use. We will focus on use of opioids and benzodiazepines for symptom management, ventilator withdrawal, and education for providers and nurses. We will then present key revisions we havemade toour comfort careorder set basedon theupdated evidence, clinical practice, and feedback from colleagues. These key revisions include educational material within the order set, such as algorithms and anopioiddecision tree. Participantswill apply these tools topatient scenarios, provide feedback, andparticipate in a large group discussion. We will also share preliminary results of provider and nursing surveys on our old and revised comfort care order sets.
Databáze: OpenAIRE
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