Identifying Palliative Care Needs in Heart Failure Patients With Nurse-Led Screening

Patients with heart failure benefit from specialty palliative care but are often not evaluated for these services. The lack of standardized screening tools and limited nurse training for assessing palliative care needs are contributing factors. This quality improvement project aimed to improve the identification of unmet palliative care needs in patients with heart failure admitted to a progressive care unit by implementing a standardized nurse-administered palliative care screening tool. The nursing staff administered the Integrated Palliative Care Outcome Scale (IPOS) tool. The number of palliative consultations before project implementation was compared with those during the project. Spearman rho was assessed for correlation between screening tool score and New York Heart Association (NYHA) heart failure class. Thirty-eight patients completed the screening tool. NYHA class was documented in 29% of patients. Among all patients, those categorized as NYHA III with heart failure with reduced ejection fraction demonstrated the highest need scores. Spearman rho indicated a nonsignificant (P > .05), very weak negative correlation between the IPOS scores and NYHA class (r(s) = -0.18, P = .60). Implementing a nurse-administered screening tool effectively identified unmet palliative care needs among patients with heart failure with reduced ejection fraction and NYHA III. Despite low rates of palliative consults, standardization using IPOS could increase screening, contribute to institutional triggering palliative consultations, and improve awareness of unmet needs.