Blog -- APRN Quality Improvement Project Blog: Provider-Associated Barriers to Hospice Referrals

The process of writing the quality improvement project for improving hospice referrals for patients suffering from end-stage dementia care was very instructive. Reading the relevant literature revealed which research questions in dementia care are considered important by scientists and care professionals and which questions have yet to be asked. Aside from helping to outline appropriate goals for the quality improvement project, this task revealed that end-stage dementia care is a relatively understudied area of medicine. Writing the literature review also uncovered a list of best practice recommendations for palliative care, in relation to dementia, which was previously unknown to me. Overall, writing the quality improvement project helped me collect best practice recommendations authored by dementia care experts and understand the state of research in palliative care for patients suffering from end-stage dementia. This in turn increased my proficiency as a nurse working in palliative medicine.

Writing the methods section for the quality improvement project forced me to think about the most important preventable barriers affecting timely and appropriate hospice referrals for this patient population, which led me to provider-associated barriers. As I scoured the literature...

This task forced me to consider my own role as a nurse working in palliative medicine and how I can contribute to the timely and appropriate provision of hospice referrals for this patient population, thereby increasing my competency.
The main barrier encountered when planning and developing this quality improvement project was the lack of published instruments, such as questionnaires and surveys, which could be used to analyze provider-associated barriers to timely hospice referrals. Luckily, a team of researchers and clinicians developed a questionnaire (Snyder, Hazelett, Allen, & Radwany, 2013) that had the potential to fill this need, once it was adapted to the specific goals of this project. Another major barrier was the difficulty of determining an accurate prognosis for patients suffering from end-stage dementia, with the best instrument developed so far producing only moderate accuracy (Mitchell et al., 2010). Despite this limitation, the provider education packet included this instrument. Currently, the adapted questionnaire has been sent to participating providers and 11 have been returned in order to…