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CS110
Milestones: A Creative Approach To Assist Family Decision Makers Of Chronically Critically Ill Patients
By: Wiencek, C. & Rees, H.; Case Western Reserve University, Cleveland, OH
For further information, please contact: clareen.wiencek@case.edu
Purpose: The chronically critically ill experience a complex syndrome of physiologic abnormalities, prolonged medical and nursing dependence, and uncertain trajectory associated with a high risk of disability, cognitive impairment, and death. Due to high morbidity and impaired decisional capacity, family members are usually faced with the responsibility of making decisions about treatment in collaboration with the critical care team. These discussions have traditionally been medically focused with a significant level of uncertainty and stress. The purpose of this project was to evaluate if milestones, objective measures of patient progress, were associated with differences in the process of communication or family satisfaction with communication.
Description: As part of an intensive communication intervention for the chronically critically ill, advanced practice nurses facilitated formal weekly meetings between the care team and family decision makers of patients on mechanical ventilation for greater than 72 hours in five adult ICUs. Medical condition, prognosis, patient goals and milestones were reviewed. Milestones, such as the patient's tolerance of weaning trials or decreased vasopressor reliance, were agreed upon. Also, these milestones were documented in the progress notes and communicated to appropriate staff. Family members and members of the team used these milestones as a measure of the patient's progress.
Evaluation/Outcomes: The use of milestones with family decision makers has been instrumental in shifting from a traditionally medical orientation to a more patient-goal centered focus of discussion. Perceived agreement between the family and physician, measures of communication process, and percentage of milestones accomplished have been measured and compared to a control group. The advanced practice nurse played a pivotal role in this creative solution to the challenges inherent in family decision making.
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