Description of Continuous Palliative Sedation Practices in a Large Health Region and Comparison with Clinical Practice Guidelines.

{"article_title":"Description of Continuous Palliative Sedation Practices in a Large Health Region and Comparison with Clinical Practice Guidelines.","author":"Abdul-Razzak A, Lemieux L, Snyman M, Perez G, Sinnarajah A","journal_title":"Journal of palliative medicine","issn":"1557-7740","isbn":"","publication_date":"2019 Sep","volume":"22","issue":"9","first_page":"1052","page_count":"","accession_number":"30939060","doi":"10.1089\/jpm.2018.0372","publisher":"Mary Ann Liebert, Inc","doctype":"Comparative Study","subjects":"Alberta; Deep Sedation standards; Guideline Adherence statistics & numerical data; Hospice Care standards; Palliative Care standards; Patient Comfort standards; Practice Guidelines as Topic; Terminal Care standards; Adult; Aged; Aged, 80 and over; Alberta; Female; Humans; Longitudinal Studies; Male; Middle Aged; Retrospective Studies","interest_area":["Emergency Medicine"," Oncology"],"abstract":"Background: Published reports of continuous palliative sedation therapy (CPST) suggest heterogeneity in practice. There is a paucity of reports that compare practice with clinical guidelines. Objectives: To assess adherence of continuous palliative sedation practices with criteria set forth in local clinical guidelines, and to describe other features including prevalence, medication dosing, duration, multidisciplinary team involvement, and concurrent therapies. Design: Retrospective chart review. Settings\/Subjects: We included cases in which a midazolam infusion was ordered at the end of life. Study sites included four adult hospitals in the Calgary health region, two hospices, and a tertiary palliative care unit. Measurements: Descriptive data, including proportion of deaths involving palliative sedation therapy, number of criteria documented, midazolam dose\/duration, concurrent symptom management therapies, and referrals to spiritual care, psychology, or social work. Results: CPST occurred in 602 out of 14,360 deaths (4.2%). Full adherence to criteria occurred in 7% of cases. The most commonly missed criteria were: a \"C2\" goals-of-care designation order (comfort care focus in the imminently dying) (84%) and documentation of imminent death in the chart (55%). Concurrent medical therapies included opioids in 98% of cases and intravenous hydration in 85% of cases. Few referrals were made to multidisciplinary care teams. Conclusions: We found low adherence to palliative sedation guidelines. This may reflect the perception that some criteria are redundant or clinically unimportant. Future work could include a study of barriers to guideline uptake, and guideline modification to provide direction on concurrent therapies and multidisciplinary team involvement.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=30939060&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Abdul-Razzak A, Lemieux L, Snyman M, Perez G, Sinnarajah A","Journal_Info":"Publisher: Mary Ann Liebert, Inc Country of Publication: United States NLM ID: 9808462 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1557-7740 (Electronic) Linking ISSN: 15577740 NLM ISO Abbreviation: J Palliat Med Subsets: MEDLINE","Publication_Type":"Comparative Study; Journal Article","Published_Date":"2019-09-01","Source":"Journal of palliative medicine [J Palliat Med] 2019 Sep; Vol. 22 (9), pp. 1052-1064. Date of Electronic Publication: 2019 Apr 02.","Languages":"English","Electronic_ISSN":"1557-7740","MeSH_Terms":"Practice Guidelines as Topic*, Deep Sedation\/*standards , Guideline Adherence\/*statistics & numerical data , Hospice Care\/*standards , Palliative Care\/*standards , Patient Comfort\/*standards , Terminal Care\/*standards, Adult ; Aged ; Aged, 80 and over ; Alberta ; Female ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Retrospective Studies","Subjects":"Adult, Aged, Aged, 80 and over, Alberta, Female, Humans, Longitudinal Studies, Male, Middle Aged, Retrospective Studies, Deep Sedation standards, Guideline Adherence statistics & numerical data, Hospice Care standards, Palliative Care standards, Patient Comfort standards, Practice Guidelines as Topic, Terminal Care standards","Title_Abbreviations":"Journal of palliative medicine","Volume":"22"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"30939060","RelevancyScore":"836","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"836.127868652344"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=30939060&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=30939060&authtype=shib&custid=ns346513&group=main&profile=eds"}