Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-11-2018

Graduate Advisor

Susan Dean-Baar

Committee

Susan Dean-Baar

Tonya Haynes

Mary Fox

Abstract

ABSTRACT

Measurements that Matter: Assessment and Management of the Symptoms of Chronic Illness Using the Integrated Palliative Outcome Scale (IPOS)

Background: The mission of the Advanced Illness Management (AIM) program at the Visiting Nurse Association of Greater St. Louis (VNA) is to relieve the burden of serious illness by providing exceptional care to patients and families through symptom management. A validated symptom tool was needed for holistic assessment.

Purpose: This is a quality-improvement project aimed at enhancing symptom management in patients experiencing advanced illness in a community-based palliative care program. Provider use of the Integrated Palliative Outcome Scale (IPOS) as an assessment tool to deliver focused interventions was explored.

Methods: The IPOS tool was embedded in the Electronic Health Record (EHR) note template. The project used the PICO framework to identify the problem. The Population of interest were new patients admitted during a 90 day period. The Intervention of interest was the use of the IPOS by providers. The Comparison of interest was the absence of the IPOS prior to the project. The Outcome of interest was the use of the IPOS and documentation of interventions.

Results: There were 62 visits in the sample. Compliance rate with use of the tool was 93.5%. Poor mobility and weakness were the most common physical symptoms. The most common psychosocial symptom was the patient’s perception of family anxiety. Poor mobility and weakness scored the highest number of aggregate symptoms: 39 and 37 times respectively. Providers intervened 74% and 76% of the time. While providers responded 100% of the time to overwhelming immobility, overwhelming weakness only received an intervention 66% of the time. The highest number of psychosocial/spiritual symptoms was the patients’ perception of family anxiety. Thirty positive responses were recorded with an aggregate score of 76% interventions. The patients’ own anxiety/worry was recorded 17 times with an aggregate intervention score of 88%.

Conclusions: Community-based palliative care programs need to be pro-active in the management of symptoms to provide holistic patient-centered care. This project used a validated tool that addresses not only the physical burden of chronic illness, but the emotional, mental, spiritual, and relationship aspects of illness.

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