Document Type

DNP Project

Publication Date

5-2022

Degree Name

Doctor of Nursing Practice

Faculty Advisor

Constance Glenn, DNP, APRN, FNP-BC

Practice Mentor

Erin Fusco, DNP, RN, OCN, FNP-BC

Second Practice Mentor

Sheryl Holiday, FNP-BC, CHPN

Abstract

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.

Comments

A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.

Creative Commons License

Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.

Available for download on Friday, May 05, 2023


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