ArticleIndian journal of palliative care
An Audit Cycle to Evaluate the Improvement in Documentation of Breathlessness and Non-Pharmacological Interventions in Palliative Care Services.
Article in Indian journal of palliative care. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: To study the documentation of breathlessness and the Non-Pharmacological Interventions (NPIs) before and after implementation of the Standard Operating Procedure (SOP). The set standard was 100% for both. The secondary aim is to study the symptom cluster. Materials and Methods: Breathlessness is a distressing symptom in patients with cancer. Management principles are based on the empirical Breathing-Thinking-Functioning model with NPI as the first line of treatment. Multidisciplinary Team (MDT) interventions are crucial for lifestyle adjustments to preserve functionality, alleviate anxiety, and train in breathing techniques. The MDT was inducted in the Department of Palliative Medicine in 2022. To assess the impact of MDT on documentation of breathlessness and NPIs, case records of adult patients with cancer, in March 2021 and March 2022 were audited. Statistical analysis was done using Epi Info. Along with documenting the severity of breathlessness, an SOP for NPI in mild, moderate, and severe breathlessness was implemented in December 2022 and the department staff were trained and sensitized. The data was collected for adult patients diagnosed with cancer over two periods; a month after the introduction of SOP for 2 consecutive months (February and March 2023) and after 8 months (September 2023). Data over the cycle was studied and analyzed using Epi Info software (version 7.2.6). Results: In 2021, (n = 391), 68% had documented breathlessness, with no documentation of NPIs. In 2022, (n = 433), breathlessness documentation increased to 80%, and NPIs to 16%. In February and March 2023, 93.4% of cases had documented breathlessness, with NPIs documented in 91.4%. In September 2023, breathlessness documentation reached 96.7%, with NPIs at 93.5%. Common symptom clusters were fatigue and anxiety. Conclusion: There was a significant improvement in the documentation of breathlessness and NPIs following MDT induction and SOP implementation. Symptom clusters such as fatigue and anxiety were commonly associated with breathlessness, highlighting the need for integrated multidisciplinary approaches in palliative care settings.
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