Background
Spirituality is a patient need that requires special attention from the Pain and Palliative Care Service (PPCS) team. This QI project aimed to provide spiritual assessment for all new outpatients with serious life-altering illnesses.
Measures
Percentage of new outpatients receiving spiritual assessment (Faith, Importance/Influence, Community, Address/Action in care [FICA], psychosocial evaluation, chaplain consults) at baseline and post-interventions.
Intervention
Interventions included encouraging clinicians to incorporate adequate spiritual assessment into patient care and implementing chaplain co-visits for all initial outpatient visits.
Outcomes
The quality improvement interventions increased spiritual assessment (baseline vs. post-interventions): chaplain co-visits (25.5% vs. 50%), FICA completion (49% vs. 72%) and psychosocial evaluation (89% vs. 94%).
Conclusions/Lessons Learned
Improved spiritual assessment in an outpatient palliative care clinic setting can occur with a multidisciplinary approach. This project also identifies data collection and documentation processes that can be targeted for improvement.
A distressing complication for patients and families, gross hematuria at the end of life challenges hospice and palliative care clinicians to utilize skills in medical and nursing management, communication and clarification of patient goals, and relief of symptom burden. Massive hemorrhage in the genitourinary tract can radically alter the terminal trajectory for patients and necessitate intensive interventions aimed at promoting comfort. Here, a case of gross hematuria in an adult hospice patient serves to broaching decision-making challenges and management strategies.
The Bereavement Program at the National Institutes of Health (NIH) Clinical Center was established in 2005. The program makes contact with the next of kin on 4 occasions postnotification of death. The objective of this analysis was to evaluate program effectiveness for those individuals who we successfully made contact with on all 4 occasions (N = 39). At 12 months postnotification, the majority viewed the NIH as a source of support (56%), and the frequency of positive emotional ratings increased (59%). There are limitations to this analysis, and biases may be present. In sum, this analysis serves as an example of a successful hospital-based bereavement program that enrolls patients who have been treated at the institution in any capacity who are also patients enrolled in institutional review board-approved research protocols.
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