Improving the process of care setting transitions for adult palliative patients: recommendations for nurse practitioner practice

The number of transitions between care settings for palliative patients increase as they approach death. In Canada, 40% of palliative patients experienced one care setting transition prior to death, 6.3% experienced five or more transitions, and 47% made at least one care setting transition in the last four weeks of life. Often, palliative patients are transferred between care settings in order to receive the care necessary to improve their quality of life. Many times these transfers lead to patient and caregiver anxiety and dissatisfaction, medication errors, and ultimately a decrease in the quality of care. The aim of this project is to answer the following question: How can nurse practitioners improve care setting transition processes for adult palliative patients in the context of primary care in British Columbia? An integrated review was undertaken and an extensive literature search was conducted by way of electronic databases, journals, reference lists, and guidelines. Results are groups into three categories or levels: system, clinician, and patient. Within these categories, the key findings in this review include improving communication, continuity of care, and multidisciplinary communication, effective medication reconciliation, adequate health information technology and improving patient and caregiver education and empowerment. Recommendations for nurse practitioners as primary care practitioner are presented in the areas of practice, education, and future research considerations. --Leaf ii.