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Implementing the Stroke Palliative Approach Pathway

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Implementing the Stroke Palliative Approach Pathway Pathway Training and Information Session Aim To provide staff caring for palliative stroke patients with the ... – PowerPoint PPT presentation

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Title: Implementing the Stroke Palliative Approach Pathway


1
Implementing the Stroke Palliative Approach
Pathway
Pathway Training and Information Session
2
Aim
  • To provide staff caring for palliative stroke
    patients with the knowledge and skills to
    implement the Stroke Palliative Approach Pathway
    (SPAP), including discharge criteria

3
Session Outline
  • Review the principles of palliative care
  • Care pathways and why we are utilising them
  • How to utilise the SPAP
  • Possibility of discharge home and how this will
    this be raised with carers / families
  • Process of discharge
  • Resources developed to support use of the SPAP

4
Principles of palliative care
  • Provides relief from pain and other distressing
    symptoms
  • Affirms life and regards death as a normal
    process
  • Intends to neither hasten nor postpone death
  • Integrates the psychological and spiritual
    aspects of patient care
  • Offers a support system to help patients live as
    actively as possible until death
  • Offers a support system to help the family cope
    during the patients illness and in their own
    bereavement
  • Uses a team approach to address the needs of
    patients and their families, including
    bereavement counselling, if indicated
  • Will enhance quality of life, and may also
    positively influence the course of illness
  • World Health Organisation (2009) WHO Definition
    of Palliative Care Geneva

5
Palliative Stroke Care
  • WHY
  • Growing interest in the role of palliative care
    in non-malignant disease, including stroke
  • Despite the high mortality and morbidity level in
    stroke, evidence to guide palliative care in this
    area is lacking
  • Limited information available on the needs of
    carers, especially in regard to possibility of
    discharge home

6
Palliative Stroke Care
  • Why develop a pathway?
  • Supports National Stroke Foundation
    recommendations (1.12)
  • Clinical Guidelines for Acute Stroke Management
    National Stroke Foundation 2007

7
Palliative Stroke Care
  • Supports recommendation nine of the Stroke Care
    Strategy for Victoria
  • Appropriate and culturally sensitive palliative
    care should be provided and communication with
    carers / family members undertaken in accordance
    with existing national guidelines and
    Strengthening palliative care policy for health
    and community care providers 2004-09

8
Care Pathways
9
Care Pathways
  • Map out a patients journey
  • the right people, doing the right things, in the
    right order, at the right time, in the right
    place, with the right outcome

10
Care Pathways
  • Main aims of utilisation
  • Help improve clinical outcomes
  • Support the introduction of evidence-based
    medicine and use of clinical guidelines
  • Improve multidisciplinary communication and care
    planning
  • Decrease unwanted practice variations
  • Improve clinician patient / family
    communication and patient satisfaction
  • Help ensure quality of care and provide a means
    of continuous quality improvement

11
Care Pathways
  • Benefits
  • Reduce variations in care from case to case (and
    consultant to consultant) in the same department
  • Facilitate the introduction of local protocols
    based on research evidence into clinical practice
  • Encourage multidisciplinary communication and
    care planning
  • Enable new staff to learn quickly the key
    interventions for specific conditions and to
    appreciate likely variations
  • Embed clinical audit into daily practice

12
Development of Stroke Palliative Approach Pathway
(SPAP)
  • Based on the Liverpool Care Pathway (LCP) and
    adapted for local use
  • Goal of pathway
  • Meet the needs of patients and their carers by
    providing timely assessment, education and access
    to palliative care services as required

13
Stroke Palliative Approach Pathway (SPAP)
  • Introduction
  • Sets out the objective, criteria and use of the
    pathway
  • Section 1
  • Initial assessment and initiation of the
    palliative approach
  • Section 2
  • Ongoing care and assessment
  • Section 3
  • Discharge home
  • Section 4
  • Verification of death

14
Utilisation of the SPAP
  • When to commence the pathway
  • How to utilise the pathway
  • Who completes each sections

15
Resources developed
  • Carer brochures
  • Palliative care after stroke Information for
    families and carers
  • Providing end of life care at home for your
    family member Information for families and
    carers
  • What to do when someone dies Information for
    families, friends and carers

16
Resources developed
  • Where they will be kept
  • Who will give resources out

17
Discharge Home
18
Why examine the process of discharge for
palliative stroke patients?
  • Population which has not been greatly examined
    from a discharge process perspective
  • To facilitate a smooth and efficient discharge
    for palliative stroke patients whose families
    would like to take their relative home to die
  • To guide staff in the process of discharging
    palliative stroke patients home (via the pathway)
  • The aim is not to persuade or ask families to
    care for their family member at home but rather
    attempt to fulfil the families wishes should they
    want to take their relative home

19
Resources to Support the Discharge of Palliative
Stroke Patients
  • Providing end of life care at home for your
    family member Information for families and
    carers brochure
  • Stroke Palliative Approach Pathway - Section 3

20
Considerations for the discharge of a palliative
stroke patient
  • The exact process will vary for each individual
    patient
  • A discussion must occur between appropriate
    senior staff and
  • the patients family / carer to determine
    proposed location of dying (and
  • documented in Section 1a of the pathway)
  • If the proposed location of dying is at home,
    this can only be confirmed
  • following all relevant Allied Health
    assessments (i.e. OT assessment of home
  • environment)
  • Potential differences to a standard acute
    discharge home
  • High carer needs (i.e. training, support)
  • - Family emotion / grief
  • - Short time frame to organise discharge
  • - Anticipate only short period (i.e.
    days) at home prior to death

21
Conclusion
  • The SPAP should be utilised for all palliative
    stroke patients after documentation in the
    medical record and discussion with the family
  • Resources should be provided to family / carers
    as needed
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