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Caring for the Unrepresented: A Podcast with Joe Dixon, Timothy Farrell, Yael Zweig

GeriPal

Let’s say they’re in the ICU now on a ventilator. So on the clinical side, people are really focused on how long do they have to be on the ventilator and managing that. Eric 27:31 They are unrepresented, they’re in the ICU on a ventilator. Should we keep them on the ventilator? Their advanced directive.

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The Case for Palliative Care in the ICU

Hospice News

Facilitating Better Communication Many patients in the ICU today have serious, life-limiting illnesses that may require family members to make urgent, difficult life-or-death decisions that may not be covered in written documents.

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POLST Evidence and Update: Kelly Vranas, Abby Dotson, Karl Steinberg, and Scott Halpern

GeriPal

Certainly SOME of those avoided hospitalizations, CPR, and ICU stays were due to documentation of those orders in the POLST. Because we haven’t done our job to document the value of what we’re doing. And I use that as that documentation about what they want, recognizing that not everybody does that.

Document 305
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Surrogate Decision Making: Bernie Lo and Laurie Dornbrand

GeriPal

Missouri set a very high bar, explicit written documentation that applies to this specific circumstance, which the Cruzan’s eventually cleared. But legislation can change, clinical practice can change, but I think what we’ll talk about today is how we’re now opening the door to conversations rather than legal rules and documents.

Document 246
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Done Right, Advance Care Planning Can Reduce High-Acuity Utilization

Hospice News

Those were a group of outcomes that we looked at that included mechanical ventilation, hospital admissions within the last 30 days of life, intensive care unit admissions, receiving cardiopulmonary resuscitation, and chemotherapy within the last two weeks of life. So these are generally seen as treatments that are futile.

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PC Trials at State of Science: Tom LeBlanc, Kate Courtright, & Corita Grudzen

GeriPal

What we did was ask clinicians earlier in the ICU stay for very sick patients to document prognosis, and for those who they thought would survive, to document six-month functional prognosis. And that helped them focus on that instead of, say, the blood pressure, the vasopressors or the ventilator settings that day. Eric: Okay.

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Checklist Prompters Support ICU Rounds

Daily Nurse

The evidence-based bundle includes various elements related to pain, agitation, delirium, ventilator care, and family engagement. The nurse observers documented 118 patient discussions, and their dually observed discussions are the basis for calculating reliability and agreement.