(P216) NURSE TO NURSE PALLIATIVE CARE REFERRAL INPATIENT SETTING

Background: Palliative care (PC) is underutilized in patients with heart failure (HF). Improved health service utilization can be addressed with the integration of PC (1). Nurses have been identified as having the required expertise to identify the need for, and provide, PC (2). A one-year hospital-wide quality initiative project (QIP) was implemented at a single tertiary cardiac centre to evaluate the feasibility and effectiveness of implementing a nurse-to-nurse PC consultation to 1) improve inpatient nursing staff competencies in PC, and 2) to include PC services earlier in the patient’s hospital admission.

METHODS AND RESULTS: The Knowledge-to-Action Framework methodology guided this QIP (3). A referral pathway was created in the electronic medical record and reason for referral included symptom management, goals of care discussion, end of life and/or other. A questionnaire including satisfaction with the QIP and self-reported PC competency assessment questions were distributed to referring nurses. An auditing tool was also created for patients referred from April 1, 2023 to April 1, 2024.
In the one-year period, there were 39 nurse-initiated PC consultations (compared to 83 physician-initiated PC consultations). Of the 39 referrals, 11 required PC physician involvement. All referring nurse respondents reported feeling more comfortable having goals of care conversations, would use the referral program again, and would recommend it to their colleagues. One nurse reported “After 20+ years as a bedside nurse, I feel there would have been many opportunities for such a referral and I wish I could have had it available not only for patient and family comfort but also in establishing dialogue and education for myself.” The consults generated by the QIP were feasible for the consultant PC nurse’s workload.
Nurse-initiated consults were referred 11 days following admission vs 15.5 for a physician-initiated consult. 61.5% of consults resulted in a category status change within an average of 3.5 days to more conservative care. 38% of those who had a nurse-initiated consult died in hospital vs. 42% following a physician-initiated consult.

Conclusion: Nurse-initiated referrals to PC resulted in earlier PC involvement and were associated with fewer patients dying in hospital. Nurses reported high satisfaction with the program without adding significant workload burden to the consultant PC nurse. Further research is required to examine the association with in-hospital death and to examine cost-effectiveness of the program.