Creation of and Experience with the End of Life Plan of Care in the EMR: A Quality Improvement Project in the Pediatric Intensive Care Unit

•Design a novel approach to documenting the plan for end of life care in the hospital setting.•Maximize interdisciplinary team communication when caring for a patient at end of life in the hospitalized setting through use of an end of life plan of care document in the EMR. Lack of clear guidelines leading to physician variability in practice combined with inaccessible documentation for a child receiving comfort care at end of life (EOL) in our PICU resulted in communication breakdowns triggering moral distress amongst staff. As part of a larger initiative to optimize EOL care in our PICU, we aim to use The End of Life Plan of Care in our EMR to improve accessible documentation of six key elements of EOL care by 50% in 12 months. A multidisciplinary group of PICU champions using data obtained from staff debriefings and 48 needs assessment surveys created The End of Life Plan of Care in our EMR. The End of Life Plan of Care is an electronic, centralized, dynamic document that all members of the care team can access to either document and/or read the most up to date plan for a child receiving comfort care. Since its creation, the End of Life Plan of Care has been utilized in 100% of patients receiving comfort care in our PICU. This tool influenced staff's medical care plans and/or conversations with the family in 100% of cases and was used to guide rounds in 67% of cases. After implementation of the EOL Plan of Care, the mean score of accessible documentation increased by 63%. Preliminary data reveals improved documentation and team communication in our PICU after implementation of The End of Life Plan of Care. A centralized dynamic document, accessible to a multidisciplinary team in the EMR holds promise to optimize provider hand off and team communication, guide rounds, and ultimately decrease staff distress and reduce variability when caring for a patient at end of life.