Oral Presentation Palliative Care Nurses Australia Conference 2022

Evaluation of a multidisciplinary response to breathlessness in community palliative care: A Stanford University Collaborative Quality Improvement Project (#8)

Angela Rao 1 , Elaine Gallagher 1 , Jake Mikelsen 2 , Carmen Sanchez 1 , Felicity Forby 1 , Kate Andrews 1 , Annmarie Hosie 3 , Michelle De Natale 4 , Meera Agar 5
  1. Calvary Health Care Kogarah, Kogarah, NSW, Australia
  2. Global Health, Stanford University, Stanford, California, United States
  3. School of Nursing, The University of Notre Dame Australia, Ultimo, NSW , Australia
  4. Stanford Health Care, Stanford, California, United States
  5. Improving Palliative Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Ultimo, NSW, Australia

Background

Breathlessness is a common symptom for patients receiving palliative care that can contribute to distress and decrease function and quality of life. As such, palliative care services aim to rapidly respond to patients with moderate or severe breathing-related distress.

Aim

To increase the proportion of patients admitted to home-based community palliative care services with moderate or severe breathing-related distress (defined as a Palliative Care Outcomes Collaborative (PCOC) Symptom Assessment Score (SAS) ≥ 4) who were re-assessed by a member of the multidisciplinary team within seven days of an initial nursing assessment.

Methods

A quality improvement (QI) initiative was conducted in one specialist community palliative care service between February and August 2021. A cause-and-effect diagram was undertaken to identify the root causes of delays in the re-assessment of breathing-related distress, which informed the development of key interventions. Key interventions included: 1) Multidisciplinary education sessions to facilitate buy-in, with nursing ownership of the project as case managers, and PCOC SAS breathing-related distress assessment and documentation of scores; 2) Access and training in electronic PCOC data entry software for allied health staff; 3) Fortnightly monitoring and reporting of PCOC data to the community palliative care team and identification of patients requiring timely assessment of breathing-related distress; 4) Development of a flowchart to support action to moderate to severe breathing-related distress.

Results

The proportion of patients re-assessed within seven days of an initial nursing assessment of moderate to severe breathing-related distress increased from 34% at baseline to 92% at six months.

Discussion/Implications for Practice

The sustainability of this QI project is demonstrated by the use of the PalCentre dashboard to monitor progress by: 1) identifying patients who are moderately distressed from their breathlessness as well as other symptoms; 2) weekly review and education within the community palliative care team to monitor and discuss accurate scoring of their patient's PCOC Phase and SAS scores, with particular attention to those patients in the deteriorating phase; and contemporaneous data entry into PalCentre software. Future research is required to evaluate if there is a need for a breathlessness-specific clinic at the local health service to alleviate unmanaged breathing-related distress.

Conclusion

A local quality improvement project increased the proportion of patients with timely re-assessment of breathing-related distress in a community palliative care service.