It has been demonstrated that pediatric palliative home-based care enhances the quality of life, symptom management, and care coordination. Despite these achievements, hospitalization rates in the home palliative home-based care population continued to be high because some caregivers had the confidence to manage symptoms at home and found it challenging to remember or obtain “sick care plans.” For a study, researchers created the Symptom Management Plan (SMP), a multi-system “sick care plan,” as a quality improvement initiative to enhance caregiver confidence in treating symptoms at home.

With the help of core subspecialists, an SMP template for the prevalent symptoms of respiratory distress, seizures, feeding intolerance, and constipation was developed. Every subsequent palliative home nursing visit involved creating and evaluating customized SMPs with the carers. Three and 6 months after implementation, a confidence survey of caregivers was conducted. The use of resources was examined as the implementation progressed.

After utilizing the SMP for 6 months, 73% of caregivers said they felt “better” or “far better” equipped to manage their child’s symptoms, and 76% thought the SMP reduced the need for ED or urgent care visits. After the SMP was implemented, the rate of emergency department (ED) visits dropped from 0.86 to 0.47 per 100 patient days to 0.39 per 100 patient days for admissions. Within 4 and 6 months, these rates dropped to 0.31 ED visits and 0.19 admissions per 100 patient days.

The introduction of the SMP for our patients receiving home-based palliative care was linked to an increase in caregiver self-assurance in handling acute symptoms at home and a decrease in hospital usage.