77 Palliative care in ICU; conversion of symptom control medications from the intravenous to subcutaneous route to facilitate ward step down

Résumé fourni par la source

End-of-life care (EOLC) is a core aspect of intensive care medicine, and maintaining excellent symptom control for patients at EOL is a key factor. Patients who are at end of life (EOL) and are receiving intravenous drug infusions to manage symptoms must be converted to continuous subcutaneous infusions (CSCI) in order to facilitate ward step down. Our aim was to assess current practice in managing symptoms at EOL, with a view to developing a regional guideline on transition from ICU to ward level care for these patients. We conducted a retrospective audit within a tertiary, medical-surgical ICU. We identified patients at EOL who required specialist palliative care team (SPCT) input by reviewing medical records over a 12-month period. Drug doses infused intravenously and subcutaneously were recorded. Symptom control was ascertained through chart review. A sample of 22 patients was analysed. 73% (n = 16) were referred to SPCT within 1–3 days of ICU discharge, many on the same day. 50% (n = 11) of patients were seen by SPCT in ICU. 58% (n= 6) of patients who stepped down to a ward had a CSCI commenced prior to ICU discharge. The mean intravenous Morphine and Midazolam doses were 93.6mg/24 hrs and 74 mg/24 hrs respectively. The mean subcutaneous doses of Morphine and Midazolam were 35.4mg/24 hrs and 37.2mg/24 hrs respectively. 89%(n = 9) of patients started on a CSCI in ICU maintained good symptom control upon ward step down. 62% (n=12) had their EOLC documentation completed in full and 58% (n=7) had a clear plan documented in their notes prior to ward step down. For patients at EOL in ICU, early involvement of the SPCT and documentation of an individualised care plan helps ensure good symptom control upon ward step down.

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