Comparing Adherence with Best Practices in End-of-Life Care After Implementing the End-of-Life Order Set: A Quality Improvement Project in an Ottawa Academic Hospital

Abstract

Background: Physicians in acute care require tools to assist them in transitioning patients from a "life prolonging"approach to "end-of-life care,"and standardized order sets can be a useful strategy. The end-of-life order set (EOLOS) was developed and implemented in the medical wards of a community academic hospital. Objective: To compare adherence with best practices in end-of-life care after implementing the EOLOS. Methods: We conducted a retrospective chart review of admitted patients with expected deaths in the year preceding EOLOS implementation ("before EOLOS"group), and in the 12 to 24 months following EOLOS implementation ("after EOLOS"group). Results: A total of 295 charts were included: 139 (47%) in the "before EOLOS"group and 156 (53%) in the "after EOLOS"group, of which 117/156 charts (75%) had a completed EOLOS. The "after EOLOS"group demonstrated more "do not resuscitate"orders and more written communication to team members about comfort goals of care. There was a decrease in nonbeneficial interventions in the last 24 hours of life in the "after EOLOS"group: high-flow oxygen, intravenous antibiotics, and deep vein thrombosis/venous thromboembolism prophylaxis. The "after EOLOS"group demonstrated increased prescription of all common end-of-life medications, except for opioids, which had a high preexisting rate of prescription. Patients in the "after EOLOS"group showed a higher rate of spiritual care and palliative care consult team consultation. Conclusion: Findings support standardized order sets as a good framework allowing generalist hospital staff to improve adherence to established palliative care principles and improve end-of-life care of hospital inpatients.