The quality of palliative sedation in end-stage disease: audit from a department of oncology and haematology

Improvement in Nurses' Knowledge of Subcutaneous Catheter Use for Pain Management

BACKGROUND

Nurses often have insufficient knowledge of subcutaneous catheter use for pain management. This quality improvement project evaluated implementation of an evidence-based subcutaneous catheter nursing policy with education to improve pain management for hospitalized patients.

METHOD

A convenience sample of nurses (N = 515) completed a posttest after online training on effective subcutaneous pain management. Patient pain ratings were assessed to evaluate whether they changed after nurses' training.

RESULTS

Posttest scores showed the online learning module effectively contributed to nurses' knowledge of subcutaneous catheter pain management. A statistically significant reduction occurred in patient pain ratings (p < .001) postintervention. The number of patients experiencing moderate or severe pain decreased by 58%, for a significant reduction in pain.

CONCLUSION

An online learning module was successful in educating nurses on pain medication administration through an indwelling subcutaneous catheter. [J Contin Educ Nurs. 2024;55(1):13-20.].

Comparison of inpatient and outpatient palliative sedation practice - A prospective observational study

INTRODUCTION

Palliative sedation (PS) is an intrusive measure to relieve patients at the end of their life from otherwise untreatable symptoms. Intensive discussion of the advantages and limitations of palliative care with the patients and their relatives should precede the initiation of PS since PS is terminated by the patient's death in most cases. Drugs for PS are usually administered intravenously. Midazolam is widely used, either alone or in combination with other substances. PS can be conducted in both inpatient and outpatient settings; however, a quality analysis comparing both modalities was missing so far.

PATIENTS AND METHODS

This prospective observational study collected data from patients undergoing PS inpatient at the palliative care unit (PCU, n = 26) or outpatient at a hospice (n = 2) or at home (specialized outpatient palliative care [SAPV], n = 31) between July 2017 and June 2018. Demographical data, indications for PS, and drug protocols were analyzed. The depth of sedation according to the Richmond Agitation Sedation Scale (RASS) and the degree of satisfaction of staff members and patient's relatives were included as parameters for quality assessment.

RESULTS

Patients undergoing PS at the PCU were slightly younger compared to outpatients (hospice and SAPV combined). Most patients suffered from malignant diseases, and midazolam was the backbone of sedation for inpatients and outpatients. The median depth of sedation was between +1 and -3 according to the RASS with a trend to deeper sedation prior to death. The median degree of satisfaction was "good," scored by staff members and by patient's relatives. Significant differences between inpatients and outpatients were not seen in protocols, depth of sedation, and degree of satisfaction.

CONCLUSION

The data support the thesis that PS is possible for inpatients and outpatients with comparable results. For choosing the best place for PS, other aspects such as patient's and relative's wishes, stress, and medical reasons should be considered.