Implementing a Comfort Care Cart: A Quality Improvement Nurse-Driven Initiative in the Intensive Care Unit

The field of critical care nursing is multidimensional and filled with opportunities to bring change to current practice. In the United States, nearly 13% of patients (range, 8%-24%) admitted to an intensive care unit (ICU) die during or after the admission (https://www.dartmouthatlas.org/interactive-apps/end-of-life-care/). Critical care nurses provide care at every stage of acute and chronic illness. Often this includes care of the patient and family at end of life, guided by palliative care principles supported by the national guidelines including the American Association of Critical Care (Dimens Crit Care Nurs 2017;36(2):110-115). While enrolled in the final registered nurse-to-bachelor of science in nursing (RN-to-BSN) course, students are challenged to complete a quality improvement (QI) project. The project leader noted a clinical problem in the ICU. The landmark Dying in America report, as well as published theories on comfort, and the Institute for Healthcare Improvement (IHI) Open School Plan-Do-Study-Act (PDSA) model were used as the theoretical foundation for a clinical practice change. This assignment was the impetus to provide items at the bedside using a comfort cart. Description of this nurse-driven pilot project initiative includes a replicable guide of implementing a comfort care cart, transforming the patient's room into a home-like atmosphere for the families at the bedside.