HITTING THE MARK WITH PALLIATIVE CARE

1
HITTING THE MARK WITH PALLIATIVE CARE

• SC ASSOCIATION FOR HEALTHCARE QUALITY
• JULY 10, 2009

2
The Carolinas Centerfor Hospice and End of Life
Care

• Two State Association
• Technical Assistance and Support for hospice
  providers
• Palliative Care Network
• End of Life Care Initiatives
• Helping every community live die well

3
The End of Life Care Umbrella
Advance care planning Palliative care
Hospice care Bereavement care
4
End of Life Care

• A continuum of care throughout our life span that
  aims to promote and improve quality of living and
  dying

5
How ACP fits into EOLC
6
All Hospice Care is Palliative Care, but

• NOT ALL PALLIATIVE CARE IS HOSPICE

7
The Focus of Palliative Care

• to promote optimal functioning with the relief
  of suffering for patients facing serious life
  threatening or debilitating illness and support
  for the best quality of life for both patients
  and their families.
• National Consensus Project Clinical Practice
  Guidelines for Quality Palliative Care,
  NHPCO, 2009

8
The National Consensus Project

• 2001 NHPCO, CAPC, AAHPM,HPNA and Last Acts set
  forth to build consensus around the definition,
  philosophy and principles of palliative care.
  Published Clinical Practice Guidelines for
  Quality Palliative Care
• 2004 Guidelines revised.
• 2006 NQF (The National Quality Forum) accepted
  and endorsed the Guidelines in their document A
  Framework for Palliative and Hospice Care Quality
  Measurement and Reporting
• 2009 Second edition of Guidelines released

9
Defining Palliative Care

• Patient and family centered care that optimizes
  quality of life by anticipating, preventing, and
  treating suffering. Palliative care throughout
  the continuum of illness involves addressing
  physical, intellectual, emotional, social, and
  spiritual needs and to facilitate patient
  autonomy, access to information and choice.
• CMS Federal Register, 2008

10
Defining Palliative Care

• Palliative care is an approach that improves the
  quality of life of patients and their families
  facing the problems associated with life
  threatening illness, through the prevention and
  relief of suffering by means of early
  identification and impeccable assessment and
  treatment of pain and other problems, physical,
  psychosocial, and spiritual.
• World Health Organization

11
Defining Palliative Care

• Palliative care is the medical specialty focused
  on relief of the pain and other symptoms of
  serious, life-threatening illness. The goal is to
  improve quality of life for patients and their
  families. Palliative care is appropriate at any
  point in an illness. It can be provided at the
  same time as curative treatment.
• Center to Advance Palliative Care

12
-OR-

• Hospice Upstream
• Supportive Care
• Comfort Care

13
Consensus

• Appropriate for all patients, all ages with a
  variety of illnesses, conditions or injuries
• Care is focused on the patient and family
• Should begin at the time of diagnosis and
  continues through cure or until death and into
  family bereavement period
• Is comprehensive
• Interdisciplinary

14
Consensus

• Attentive to relief of suffering
• Effective communication skills are necessary
• Skill and competency in care of the dying and
  bereaved is required
• Continuity of care across settings is essential
• Accessible

15
AND

• Committed to quality assessment and performance
  improvement and evaluation of outcomes
• Timely
• Patient-centered
• Beneficial and effective
• Accessible and equitable
• Knowledge and evidence-based
• Efficient and designed to meet the actual needs
  of the patient
• Safe
• SOUND FAMILIAR?????

16
Why Should Hospitals Provide Palliative Care?

• Expand the care continuum
• Improve quality of care for patients and their
  families
• Appropriately utilize all resources
• Reduce costs
• Its the right thing to do

17
National Quality Forum Preferred Practices for
Palliative Care

• 38 preferred practices/standards in 8 domains
• Processes and Structure of Care
• Physical Aspects of Care
• Psychological and Psychiatric Aspects of Care
• Social Aspects of Care
• Spiritual, Religious, and Existential Aspects of
  Care
• Cultural Aspects of Care
• Care of the Imminently Dying Patient
• Ethical and Legal Aspects of Care

18
Safe avoid injury from care that is intended to
help

• Provide adequate training to staff
• Provide education and support to families
• Assess and manage symptoms and side effects
• Provide adequate dosages of medications

19
Effective match care to science, avoid underuse
of effective care and overuse of ineffective care

• PC Professionals should be trained, credentialed
  or certified in their area of expertise
• Provide continuing education to all members of
  the interdisciplinary team
• Encourage collaboration between PC professionals
  and primary healthcare providers
• Promote ACP

20
Patient-centered honor the individual and
respect choice

• Formulate a comprehensive care plan based on the
  goals of care
• Ensure that goals and preferences are
  communicated upon transfer between care settings
• Incorporate cultural aspects in assessment and
  care
• Routinely ascertain and document patient and
  family choices/preferences throughout the course
  of care

21
Timely prompt attention benefits both the
patient and family

• Provide access to palliative care services 24/7
• Assess and manage symptoms and side effects in a
  timely manner
• Offer bereavement services prior to and after
  death
• Formulate and regularly review a timely care plan

22
Efficient reduce waste

• Conduct care conferences including all members of
  the care team
• Constantly assess the needs of the needs of the
  patient and family
• Develop collaborative relationships for timely
  transfers and care
• Promote advance care planning

23
Equitable race, ethnicity, gender, and income
should not prevent care

• Palliative care should be offered as needed
• Choices and preferences should not influence
  access to care
• Provide professional interpreter services if
  needed
• Utilize educational materials which are
  culturally sensitive and in the patient/familys
  preferred language

24
For More Information

• Tamra N. West
• Director of SC Programs
• 803-791-4220
• twest_at_carolinasendoflifecare.org