Date of Award/Publication
2023
Document Type
DNP Project Manuscript
Degree Name
Doctor of Nursing Practice
First Supervisor
Dr. Tara Sacco
Second Supervisor
Dr. Deborah Hurley
Abstract
Background: Ischemic strokes affect nearly 795,000 people yearly. Approximately 20% of patients with an acute ischemic stroke (AIS) will need an intensive care unit (ICU) admission, and less than 20% of these patients have a good neurological outcome at six months. In patients with AIS goals of care (GOC) discussions are required to ensure care remains goal concordant. There continues to be a gap of GOC discussions and documentation in the ICU, for which the cause can be multifactorial, but identification of patients in need remains one of the leading factors. Methods: This was a two-stage quality improvement project implemented to evaluate use of the SuPPoRT checklist in critically ill patients with AIS. First, the checklist was sent to a multidisciplinary group of experts; the results informed a retrospective chart review. The chart review was completed on every patient admitted to the ICU after being diagnosed with an AIS from July 2022 through June 2023. Data from the chart review was used to identify which patients would have been recommended for a GOC discussion according to the SuPPoRTT checklist. Demographic information, stroke severity, treatment, and confirmation of a GOC discussion was also collected. Results: The multidisciplinary panel supported the use of SuPPoRTT checklist in this population. In the chart review, 54.4% of patients were identified to have a GOC need, whereas only 14.4% of patients actually received a GOC discussion. Using a McNemar Chi-square, there was a significant difference (π2(df) = 5.577, p < .018) between patients who were identified as needing a GOC discussion and those who had a documented GOC discussion. Conclusion: In this analysis, use of the SuPPoRTT checklist was supported. Further, this tool was found to be useful in identifying patients who are admitted to the ICU post-AIS who need a GOC discussion.
Recommended Citation
Nugent, Brandon P., "Goals of Care Identification Tool in the Surgical ICU/Neuro-Critical Care Unit: A Tool Exploration" (2023). Nursing Doctoral. Paper 18.
https://fisherpub.sjf.edu/nursing_etd_doctoral/18
Please note that the Recommended Citation provides general citation information and may not be appropriate for your discipline. To receive help in creating a citation based on your discipline, please visit http://libguides.sjfc.edu/citations.