Temiskaming Hospital Hospice Palliative Care. Presented by: Dr. Don Davies January 31, 2017

Transcription

1 Temiskaming Hospital Hospice Palliative Care Presented by: Dr. Don Davies January 31, 2017

2 Objectives Talk a little about Palliative Care. In general A quick look at Temiskaming District and Hospice Model Referral Process Admission to Hospice Tool time (PPS, PPI, ESAS) Palliative Care Order Set.. Just off the press

3 Palliative Care Redefined Traditional Model of Care ( ) Curative or life-prolonging treatment Palliative care Adapted from Cancer Pain Relief and Palliative Care. Technical Report Series 804. Geneva: World Health Organization,

4 Palliative Care Redefined There are 3 typical trajectories that lead to death 1) Sudden Death Few of us will die this way (accidents, cardiac or cerebral events) 2) Steady Rapid Decline 29 % of deaths result from a progressive & predictable disease such as cancer 3) Slow Progressive Decline (heart disease, stroke, COPD, renal failure and Alzheimer s disease. 90% of us will die with one or more chronic illnesses 2004 Dr. Larry Librach 4

5 Palliative Care Redefined HPC 2002 redefined by CHPCA Hospice palliative care is a philosophy of care that aims to relieve suffering and improve the quality of living and dying. It strives to help individuals and families to: address physical, psychological, social, spiritual and practical issues, and their associated expectations, needs, hopes and fears prepare for and manage self-determined life closure and the dying process cope with loss and grief during the illness &bereavement treat all active issues prevent new issues from occurring promote opportunities for meaningful and valuable experiences, personal and spiritual growth, and self-actualization. 5

6 Palliative Care Redefined Palliative Care Is Not a person, place or program It Is o o o A philosophy or an approach to care A clinical specialty with specific skill sets A focus on individualized patient centered care at any stage of the illness using a palliative care approach 6

7 Palliative Care Redefined The Role of Hospice Palliative Care During Illness (Canadian Hospice Palliative Care Association model ) Care to modify disease Focus of Care Hospice Palliative Care to relieve suffering and/or improve quality of life Presentation/ Diagnosis Time Individual s Death Illness Bereavement Acute Chronic Advanced Life-threatening End-of-Life Care 7

8 PSO Rounds Carolyn Taylor

9 Residential Hospice Beds Capacity Planning in Timiskaming Timiskaming Population in % expected to die within the year Kirkland Lake 12, Englehart 3, Temiskaming Shores 16, Timiskaming -total 33,

10 Hospice Beds Provincial Formula 6 beds / 100,000 population 6 x 33, Residential Hospice Beds Capacity Planning in Timiskaming Timiskaming total population ,325 = 1.99 Hospice Care Beds are needed within Timiskaming 10

11 Rural HPC Co-Location Model 11

12 Rural HPC Co-Location Model This Model Focuses on providing: A Dedicated Care Setting within an existing infrastructure Palliative Care Approach Admission Criteria Partnerships collaboration and integration The model includes a vision to enhance and develop more coordination in care delivery & transitions of care 12

13 COMMUNITY HOSPICE Kirkland Lake October 19, 2013 KDH 13

14 COMMUNITY HOSPICE Englehart October

15 Community Hospice Temiskaming Shores Beverly-Ann Boros Hospice Suite

16 Temiskaming Shores Hospice January 2017

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18 Community Referral to Hospice Suite Referrals are made by the NE CCAC, physician, nurse practitioner or any combination of the above. Direct admission from the community is available. Colleen MacNeil, Palliative Care Coordinator reviews all referrals and keeps an up to date list of all potential Hospice patients List is shared with Charge nurses for after hours and weekend admissions

19 Community Referral Form See package

20 In-Patient Referral to Hospice Suite In-patient referrals to the hospice suite can be made at any time. Complete internal Hospice Palliative Care (HPC) Referral form. Simple tick form to ensure eligibility and for tracking purposes. Medical information on hospital chart Forms are available in all clinical areas. Referrals are sent to Colleen MacNeil.

21 See package In Patient Referral Form

22 Admission Referral reviewed for eligibility criteria. The referring provider will be notified if the patient meets the criteria for the hospice suite. If the criteria is not met or patient no longer meets admission criteria, the MRP will be notified. Original referral can be resubmitted with an updated PPS. A wait list will be maintained. Patient prioritization process is based on the Palliative Performance Scale (PPS) and eligibility criteria.

23 Admission Criteria Progressive life limiting illness. PPS of 40% or less; priority will be given to the lower PPS score. Resides in District of Timiskaming or wishing to return to the area. No longer receiving active disease modifying treatment. Requires DNR order. Have consented to admission to hospital/ hospice care, and will be accompanied by family members as required Life expectancy of less than 3 months. Assessed by physician or NP in last 2 weeks.

24 Exclusion Criteria Wish to continue active/ curative treatment Medical or nursing needs whose complexity/ or supervision requires a nurse to patient ratio that is greater than can be accommodated by the Hospice program s model of care Behaviors that are abusive/ aggressive and may cause harm to self, others or property Behaviors (including wandering) that require closer monitoring in another location on the nursing unit

25 Palliative Performance Scale (PPS)

26 What is the PPS? Valid, reliable tool for use with palliative care patients Developed by Hospice Victoria PPS is used to classify the stage of the illness according to the client s functional performance. 5 categories - measured in 10% increments; decremental stages (0-100%)

27 Developed by Victoria Hospice Society

28 Purpose of PPS Measure progressive decline/impact of illness Identify if patient is moving closer to death (not prognostic) Common language for describing patient s condition & associated needs Indicate possible workload

29 Example #1 of PPS Assignment Patient is up and about on own Recent recurrence of disease Can do household chores but cannot go to work Occasional assistance with self care (caregiver watches patient get in & out of shower when he feels weak) Intake reduced from normal but still adequate Fully conscious with no confusion

30 Example #1 of PPS Assignment PPS score 70%

31 Example #2 of PPS Assignment Patient spends majority of day sitting in bed or lying down due to fatigue from advanced disease Requires considerable assistance to walk even for short distances Fully conscious Good intake

32 Example #2 of PPS Assignment PPS score 50%

33 Example #3 of PPS Assignment Patient is very weak and in chair couple of hours a day rest of time in bed Advanced disease Requiring almost complete assistance with self care & feeding Decreased intake few small snack size meals remain unfinished adequate fluid intake Drowsy but not confused

34 Example #3 of PPS Assignment PPS score 40%

35 Palliative Prognostic Index (PPI)

36 The Edmonton Symptom Assessment Scale (ESAS) No pain Worst possible pain

37 What is the ESAS? Evidence-based tool to be used with persons receiving palliative care, at any stage of their illness trajectory Assists in the assessment of 9 common symptoms experienced by individuals diagnosed with cancer, or any other life threatening illness Pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, wellbeing, shortness of breath, and other problems (eg. bowel function)

38 Edmonton System Assessment Scale (ESAS) No Pain Worst Possible Pain Not Tired Worst Possible Tiredness Not Nauseated Worst Possible Nausea Not Depressed Worst Possible Depression Not Anxious Worst Possible Anxiety Not Drowsy Worst Possible Drowsiness Best Appetite Worst Possible Appetite Best Feeling of Well-Being No Shortness of Breath Worst Possible Feeling of Well- Being Worst Possible Shortness of Breath Other Problem Patient s Name: Date: Time: Completed by: Patient / caregiver / Caregiver Assisted

39 Edmonton Symptom Assessment Scale (ESAS) Measures severity of symptom at the time of assessment / Identifies issues Numerical scale = symptom absent 10 = worse possible symptom severity Not a complete symptom assessment ESAS is one part of holistic clinical assessment

40 Purpose / Benefits of Using ESAS? Standardized screening tool for symptoms Used in many sites across Canada, and internationally (developed Edmonton AB) Determines severity of symptom from the person s perspective Quickly identify issues that are of priority & concern Promotes person directed care & empowerment

41 Purpose / Benefits of Using ESAS? Provides clinical profile of symptom severity over time Promotes effective communication between providers and across settings Provides a simple, valid tool to measure the effectiveness of interventions Excellent audit tool for your organization

42 Who Completes the ESAS? Ideally patient & family are taught how to complete the ESAS Gold standard: the person with the symptoms identifies the issues and determines the severity (subjective data) If person cognitively impaired, it is completed by caregiver or health professional (with or without involvement of person depending on level of cognitive impairment) If health care provider completing on own, administer at end of patient contact Not as reliable if done by caregiver / objective data

43 Temiskaming Hospital. Palliative Care Order Set

44 Palliative Care Admission Order Set

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52 Questions???