End-of-life issues experienced by the nurse-led rapid response team: An analysis of extent and experiences.

OBJECTIVES: To examine the frequency, clinical characteristics and nurse-led rapid response team experiences of calls that involve end-of-life issues. RESEARCH METHODOLOGY AND DESIGN: The study consisted of two parts: 1) a retrospective journal audit of registered rapid response team calls for 2011-2019 that involved end-of-life issues, and 2) interviews with intensive care rapid response team nurses. The quantitative data were analysed with descriptive statistics and the qualitative data with content analysis. SETTING: The study was conducted at a Danish university hospital. RESULTS: Twelve percent (269/2,319) of the rapid response team calls involved end-of-life issues. "No indication for intensive care therapy" and "Do not resuscitate" were the main medical end-of-life orders. The patients had a mean age of 80 years, and the main reason for the calls was a respiratory problem. Ten rapid response team nurses were interviewed, and four themes evolved from the analysis: "Uncertain roles for the rapid response team nurses", "Solidarity with ward nurses", "Lack of information" and "Timing of decision-making". CONCLUSION: Twelve percent of the rapid response team calls involved end-of-life issues. The main reason for these calls was a respiratory problem, and the rapid response team nurses often found their role uncertain and experienced lack of information and sub-optimal timing of decision-making. IMPLICATIONS FOR CLINICAL PRACTICE: Intensive care nurses working in a rapid response team often face end-of-life issues during calls. Therefore, end-of-life care should be included in training for rapid response team nurses. Furthermore, advanced care planning is recommended to secure high-quality end-of-life care and to decrease uncertainty in acute medical situations.

Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm.

BACKGROUND: Acute and persistent pain after surgery is well described. However, no large-scale studies on immediate postoperative pain in the operating room (OR) exist, hindering potential areas of research to improve clinical outcomes. Thus, we aimed to describe the occurrence and severity of immediate postoperative pain in a large, unselected cohort. METHODS: This was a prospective cohort study, encompassing all procedures in 31 public hospitals in the Danish Realm, during a 5-day period including the weekend. Data on procedures and anesthesia were collected and the main outcome was occurrence of moderate or severe pain in the OR. Secondary outcomes included pain, sedation and nausea in the OR or during the first 15 min in the postanesthesia care unit (PACU) including relevant risk factors. Descriptive and logistic regression statistics were used. RESULTS: A total of 3675 procedures were included for analysis (87% inclusion rate). Moderate or severe pain occurred in 7.4% (95% CI 6.5% to 8.3%) of cases in the OR immediately after awakening, rising to 20.2% in the OR and/or PACU. Large intraprocedure and interprocedure variations occurred (0.0%-37.5%), and in 20% of cases with epidural-general anesthesia patients experienced moderate or severe pain. Independent risk factors were female sex, younger age, preoperative pain, daily opioid use and major surgical procedures. CONCLUSION: Moderate or severe pain in the immediate postoperative phase occurred in 20% of all cases with procedure and anesthesiological technique variations, suggesting a need for identification of relevant procedure-specific risk factors and development of preventive treatments. TRIAL REGISTRATION NUMBER: RoPR ID 43191.