Doctor of Nursing Practice
Constance Glenn, DNP, APRN, FNP-BC
Erin Fusco, DNP, RN, OCN, FNP-BC
Second Practice Mentor
Sheryl Holiday, FNP-BC, CHPN
Background: Palliative care consult (PCC) is an approach that can improve the quality of life and symptom management of patients facing life-threatening illnesses. At a 20-bed medical oncology unit in Connecticut, patients with poor prognosis and worsening symptoms have high re-admission rates within 30 days of post-hospital discharge; yet healthcare providers fail to initiate PCC.
Purpose: This project hypothesizes how implementing a nurse-driven PCC on admission or hospital stays compared to the timing of a physician to a physician PCC improves a plan of care for oncology patients? Will it result in a decrease in 30-day re-admission rates? The goal of this project is relevant to the quadruple aim. Without an improved clinical experience from healthcare providers, the other patient-centric aspects would not be able to reach their optimization over time fully.
Method: The Registered nurse will request and initiate a PCC for patients with a Karnofsky Performance Scale (KPS) score of 50%, rather than usual care, which is to have the physician initiate PCC. A retrospective chart analysis was conducted to identify whether admitted
patients had received PCC. A pilot of the KPS was conducted for three months to educate nurses on implementing PCC. The expected outcome was to improve PCC, reduce initiation time, and reduce the re-admission rate. According to specific measures relating to the triple aim, the project goals/-comes evaluated applied to the practice problem.
Results: Data showed that 26 newly diagnosed patients experiencing symptoms were admitted. Among those with a KPS of 50%, a total of 6 patients had received a nurse-driven PCC. During the intervention period, the remaining patients were assessed and found to have a KPS >50%. This suggested that attention to palliation was not needed.
Conclusion: Using KPS to implement a nurse-driven PCC can reduce the re-admission rate and improve PCC and the initiation time. The sustainable plan will not happen overnight; rather, as a continuous change over time that will have a compounding effect on the population under study.
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Sebourne-Francis, S. (2022). Implementation of a nurse driven palliative care consult: A quality improvement project. [Unpublished DNP project]. Sacred Heart University.
Available for download on Friday, May 05, 2023