How nurses, pharmacists can improve palliative care

Both nurses and pharmacists can play key roles in consulting with patients and their families about palliative care and then managing that care, two new studies show.

The first study, published in Critical Care Nurse, noted that nurses and nurse practitioners can overcome common barriers to palliative care consultations. Examples of their involvement: Including palliative-care nurse practitioners in daily rounds, identifying at-risk patients and requiring consultations when certain hospital-identified criteria are met.

"Barriers to palliative care consultation for critical care patients include misunderstandings about palliative care and a lack of agreed-upon criteria for referral to palliative care," the researchers noted. "Critical care nurses can help overcome these barriers by ensuring that other healthcare providers, patients and patients' families understand the services that palliative care provides and the benefits it brings to patients and families."

The study noted that palliative care discussions conducted by surgeons "were often quick, inadequate, and ineffective."

Nurses, on the other hand, spend more time than anyone with patients and their families and have a good sense of when palliative care can benefit patients, as FierceHealthcare has reported.

Having nurse or nurse practitioner champions present was a common thread in strategies that successfully integrated palliative care into critical care, the researchers found. The nurses were respected in the critical care environment and were "compelling advocates" for palliative care consultations. 

Nurses also need to be involved in all stages of palliative care, the study found, from documenting decisions and actions to monitoring patients for signs of distress and alerting care teams to resolve difficulties. They also can ensure that consistent messages of support are conveyed to patients and their families.

The second study addressing pharmacists' role in palliative care was presented this week at the American College of Clinical Pharmacy 2015 Global Conference. Researchers found that pharmacist intervention decreased the average acute-pain score of patients by 2.6 points on a 10-point scale, and the average chronic-pain score by 2.8 points.

Pharmacists also recommended discontinuing certain treatments and tests that didn't support palliative care goals, including chemotherapy, antimicrobials and medications, saving $100,000 in the one-year study period, according to a Medscape Medical News article.

The team-based approach included a pharmacist, physician, nurse practitioner, nurse, social worker and a chaplain. The pharmacist went on palliative team rounds three times a week, interacting directly with patients and team members rather than consulting over the phone, the article noted. As a result, pharmacists had consulted in the treatment of 70 percent of patients who died in the hospital, up from 23 percent.

The pharmacist helped achieve pain goals and improve symptoms for 91 percent of patients, the study found.

The size of a hospital is a major factor not only in which providers are involved in palliative care consultations, but whether the facility even has a palliative care program. About 90 percent of hospitals with 300-plus beds have palliative care programs, but only about half of smaller hospitals provide palliative care. For-profit hospitals also were less likely to offer palliative care programs than nonprofit hospitals, research shows.

For more information:
- read the study
- here's the Medscape article (registration required)