ICU receives Evidence-Based Practice Award

Brigham and Women’s Faulkner Hospital’s Evidence-Based Practice Award was established in 2019 by the Department of Nursing to be given in recognition of a multidisciplinary unit-based team or committee with a project that contributes to evidence-based practice. Initially the award was given by the Professional Advancement and Recognition Committee as part of the annual Nurse Recognition Awards ceremony. This year, the award was given for the first time by the Evidence-Based Practice/Research Committee during the Fall Nursing Summit to the team from the ICU.

The ICU was nominated for the Evidence-Based Practice Award for their Nurse Driven Palliative Care Consults project.

The scope of the project was explained in the team’s nomination:

Patients admitted to the ICU have serious illnesses with complex medical needs. Patients and families need support with decision making and care options. Evidence supports that involving the palliative care team within 48 hours of admission to the ICU decreases overall length of ICU and hospital stay, reduces ICU mortality rates, reduces health care costs and improves the quality of life for patients.

Critical care nurses identified that there was a lack of standardized criteria to identify patients in need of palliative care consults in the ICU. When PCCs were initiated, it was often very late in the patient’s stay in the ICU preventing initiation of palliative care services in a timely manner. Since consults must be initiated by a provider in this organization, critical care nurses wanted to identify a creative strategy to address this gap.

After a review of the literature, nurses collaborated with the palliative care team and selected the Palliative Performance Scale (PPS) to objectively identify ICU patients in need of palliative care services. The unit-based council (UBC) members became champions of the PPS and educated the ICU nurses and responding clinicians on the benefit and use of the PPS.

Patients are screened at the time of admission and if there is a change in the patient’s status. The EHR worklist is used to remind staff to document the PPS. Patients who score less than 40% on the PPS are deemed eligible for a PCC. The patient’s nurse is responsible for discussing the PPS score with the team during bedside rounds which occur at least twice a day and in nursing handoff. After this discussion, providers are encouraged to enter the PCC.

Since the pilot of this program, a Best Practice Advisory (BPA) was developed with the assistance of Paula Wolski. The BPA fires to the provider when a PPS score less than or equal to 40% is obtained. The provider then has the opportunity to order the PCC.

In addition, the project was disseminated to the MGB Critical Care Collaborative and instructed on the use of the PPS and BPA.

ICU Nurse Director Estier Sayegh, MBA, BSN, RN, CCRN, PCCN, CNRN, was on hand at the Fall Nursing Summit along with several members of her team to receive the award. “The ICU as a whole team, including nursing, respiratory, APPs and physicians, are honored to receive this award to make better decisions at the bedside to achieve desired outcomes for patients and their families,” she says. “This award is a great testament to the work we do for our patients in the ICU based on the most up-to-date science.”

Published 11/9/22