Facilitating End-of-Life Care Discussions in the Emergency Department

Abstract

Purpose: The purpose of this Doctor of Nursing Practice project is to increase emergency room nurses’ personal initiative to engage in EOLC discussions by utilizing the PREPARED CPG. Background: While it is the duty of healthcare practitioners (HCP) to initiate end-of-life care (EOLC) discussions with their patients, less than one-third report receiving education in such discussions, and 46% report frequently being unsure of what to say in such discussions. Over 25% of Medicare costs occur in the last year of the patient’s life, attributable to multiple hospitalizations and medically futile, costly interventions being performed. Approximately 75% of Americans do not have an Advance Directive in place. HCP need the tools and support necessary to confidently engage in proactive discussions about EOLC with their patients, ultimately avoiding costly and unwarranted medical interventions. Methods: A quantitative descriptive design was used to assess current personal practice of participants and factors associated with their use of the PREPARED CPG to facilitate EOLC discussions. Thirty emergency department (ED) nurses were educated on the CPG and completed a demographic survey, pre-education survey, and post-education survey. To be considered for inclusion ED nurses had to: (a) be core staff, (b) not in management or administration, and (c) consent. Exclusions included travel, float, and charge nurses. All aspects of project preparation and implementation were aligned with the Joanna Briggs Institute Model of Evidence-based Healthcare. Results: Most participants reported that they “sometimes” educate their patients/families on the difference between “full code” status and “DNR” (n=12, 40%). The most frequently reported reason participants did not engage in EOLC discussions was difficulty with the patient’s family (n=14, 46.7%). Nearly all participants found the PREPARED acronym easy to understand and practical for use in the ED (93.3% and 76.7%, respectively). Most respondents stated they will use this information in their practice and reported a degree of increased confidence to engage in EOLC discussions (93.3% each). Conclusion: Results may be used to identify the need for EOLC discussion education and protocols in healthcare facilities. Feedback elicited may help to identify areas of interest for future research.