Publication Date
Spring 2023
Degree Type
Doctoral Project
Degree Name
Doctor of Nursing Practice (DNP)
Department
Nursing
First Advisor
Robin L. Whitney
Second Advisor
Denise Dawkins
Third Advisor
Dulce E. Alcantara
Keywords
palliative care, LVAD, left ventricular assist device, script, heart failure, quality improvement
Abstract
For patients with advanced heart failure (HF) ineligible for or awaiting heart transplantation, left ventricular assist device (LVAD) implantation can be considered. LVADs have helped to improve recipients’ survival rates and quality of life. However, LVAD patients are at risk for complications such as stroke, bleeding, infection, and right ventricular failure. Moreover, events such as end-stage malignancy or progression of a neurodegenerative disorder may occur. Such complications and repeated hospitalizations can pose questions about the acceptability of LVAD therapy. As such, both the Centers for Medicare and Medicaid Services and The Joint Commission require that palliative care (PC) be part of the multidisciplinary team prior to and following VAD placement. However, execution of this mandate is unclear, leaving specifics up to the discretion of individual healthcare facilities. At our facility, all patients being evaluated for LVAD implantation must receive a PC consultation. However, confusion around the objectives and structure of this consultation persists. Therefore, the purpose of this project was to implement an evidence-based, semi-structured script to guide pre-LVAD PC consultations. Training on the script was provided to PC clinicians, and pre- and post-surveys helped to identify whether this script improved confidence in PC clinicians conducting pre-LVAD consultations. Confidence levels remained generally unchanged. However, valuable insight was gained through written feedback. Namely, clinicians felt the script provided structure and guidance but that script verbiage and flow could be improved. Moreover, clinicians expressed that communication from the HF team and a standardized workflow between PC and HF teams would be beneficial.
Recommended Citation
Szeto, Deborah A., "Standardizing Initial Inpatient Palliative Care Consultations for Patients Receiving Left Ventricular Assist Devices at a Large Urban Hospital" (2023). Doctoral Projects. 165.
DOI: https://doi.org/10.31979/etd.8nj4-a7vv
https://scholarworks.sjsu.edu/etd_doctoral/165
