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Palliative Medicine, Vol. 22, No. 4, 343-349 (2008)
DOI: 10.1177/0269216308090169

research-article

Use of a palliative care order set to improve resident comfort with symptom management in palliative care

BR Jarabek

Internal Medicine Residency Programme, Mayo Clinic, Rochester, Minnesota, jarabek.bryan{at}mayo.edu

AA Jama

Internal Medicine Residency Programme, Mayo Clinic, Rochester, Minnesota

SS Cha

Division of Biostatistics, Mayo Clinic, Rochester, Minnesota

SR Ruegg

Department of Nursing, Mayo Clinic, Rochester, Minnesota

TJ Moynihan

Department of Oncology, Mayo Clinic, Rochester, Minnesota

FS McDonald

Division of General Internal Medicine-Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota

Although one-fourth of all medicare dollars are spent during the last year of life, symptom management for terminal hospitalized patients has continued to be inadequate. Quality end-of-life care is often overlooked, seldom taught and rarely measured within Internal Medicine Residency Programmes. We studied the effects of a palliative care order set and educational e-mail on resident comfort. Survey of residents showed that only 54% were comfortable across nine aspects of palliative care. Three months after release, 88% of residents were using the order set and 63% believed it increased their comfort with palliative care. Resident comfort managing palliative symptoms increased an average 10% (P = 0.02). First-year residents exposed to this order set increased in comfort from 40% to 65% (P < 0.0001), which significantly surpassed the 48% of second-year residents who reported being comfortable (P = 0.002). Introducing a palliative care order set improves resident comfort with symptom management in dying patients.

Key Words: palliative care • pain order set • outcome based education • systems based practice


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