PCAD Introduction

Purpose of PCAD:

The Goals of PCAD are to:

• Respect patient autonomy, values, and decisions
• Continually clarify the goals of care
• Minimize symptom distress at the end of life
• Optimize appropriate supportive interventions and consultations
• Reduce unnecessary interventions
• Support families by coordinating services
• Eliminate unnecessary regulations
• Provide bereavement services for families and staff
• Facilitate the transition to alternative care settings, such as hospice, when appropriate

PCAD consists of three components (forms are available in .pdf format):

• PCAD Care Path – the interdisciplinary plan of care
• PCAD Daily Patient Care Flowsheet – an interdisciplinary documentation tool for daily assessments and interventions
• PCAD Healthcare Provider/MD-Order Sheet – a documentation tool and suggestions for symptom control approaches

Process for utilization of PCAD Pathway (See Flowchart below):

Step 1: Patient Identification

Identification of a patient that is likely to die during this hospitalization (i.e., likely to die within minutes to days) by any staff member. Any staff member or others listed may suggest a patient for PCAD

Step 2: Interdisciplinary Assessment

Interdisciplinary assessment of the patient for PCAD and discussion with the primary healthcare provider – The unit leadership assesses the appropriateness of the patient for PCAD and initiates an order for PCAD with the primary healthcare provider.

Step 3: Provider Clarification

Clarification of goals of care with the patient/family by the primary healthcare provider – The primary healthcare provider clarifies the goals of care with the patient and/or family and orders PCAD if end-of-life supportive care is the primary goal of care.

Step 4: Implementation

The primary healthcare provider orders PCAD using the PCAD Provider Order Sheet and rewrites the orders for the patient. Nurses complete the demographic information on the PCAD Pathway and initiate a PCAD Daily Patient Care Flowsheet.

Step 5: Discharge

The patient is discharged to an alternative care setting or dies on unit. A family bereavement policy is initiated (e.g., condolence card and educational materials sent) and a staff debriefing session is conducted.