The Palliative Care Team MMH

1
The Palliative Care Team _at_ MMH

• August
• 2009

2
What is Palliative?

• Websters online dictionary defines palliative
  as
• Moderating pain or sorrow by making it
• easier to bear

3
Defining Palliative Care

• Recent medical advances have resulted in patients
  living longer with severe or complicated
  diseases.
• Palliative Medicine, as a medical specialty, has
  evolved with a focus on the many ways serious
  illness affects patients and their families.
• The goal of Palliative Medicine is to help
  patients and families manage physical and
  non-physical suffering that disease may bring.

4
What is Palliative Medicine ?

• In the 1980s hospice and palliative care
  were used interchangeably. Both terms were used
  to refer to end of life care and were
  predominantly associated with cancer related
  diagnoses.
• Palliative Care centers on relieving suffering
  and enhancing quality of life throughout the
  disease process.
• Therefore Palliative Care physicians are
  consulted for patients at any stage of their
  illness.

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Life Limiting Illness

• Palliative Care addresses pain and/or symptom
  management related to disease.
• Patients are not necessarily dying, but have an
  illness that is life limiting in some way.
• A life limiting illness can be identified with a
  new diagnosis, but is also suggested by advancing
  disease, 2 or more hospitalizations in last 6
  months for the same symptoms, or being 70 y.o. or
  older with multiple co-morbidities

6
One Member of the Patients Team

• The Palliative Care physician or ARNP
  participates as a member of the
  multi-disciplinary team and works in partnership
  with the primary physician and other team members
  caring for the patient and their family.
• The patients other physicians continue to treat
  the patient just as they have been, without
  disruption to treatment. The Palliative Care
  team makes recommendations for treatment
  modifications or changes.
• Palliative Care is covered like any other medical
  consultation. Medicare will pay for both
  palliative care and medical care. Palliative Care
  is also covered by Medicaid and most insurance.

7
What Palliative Care includes

• Palliative Care consultation provides
  interventions such as
• Reducing and controlling pain symptoms
  that can
• interfere with activities of daily
  life.
• Counseling patients and families when
  making medical
• decisions become difficult.
• Listening to and supporting patients and
  their families during all stages of illness.

8
Palliative Care Pain Management

• Palliative Cares goal of preventing and
  relieving suffering
• by reducing and controlling pain symptoms is
  closely
• aligned with the national focus on pain
  management.
• Pain Management is an indicator included in
  publicly
• reported patient satisfaction data (HCAHPS)
• Pain Management is monitored closely by the Joint
  
• Commission and WHO as a standard of care for
  quality
• healthcare.

9
Palliative Care can also assist patients and
staff through

• Conducting family conferences
• Discussing prognosis and exploring options
• Supporting those with advancing disease to seek
  active treatment
• Assisting with Advance Directives
• Providing education and information
• Providing a listening presence
• Easing the transition from curative to comfort
  care
• Seeing the patient in a hospital, home, LTC or
  ALF
• Providing psychosocial support

10
Meet The MMH Palliative Care Team

• Our on-staff Palliative Care Team members are
• Dr. Joelle Angsten
• Dr. Daniel Grandrimo
• Beth Reilly, ARNP
• Karen McGough, ARNP
• Their office is located in the north-center
  hallway on 2 Tower.
• Alena Vasher, the Staff Coordinator, answers
• 552-7508 Monday - Friday 9 to 5.

11
If you want further information

• You can contact the Palliative Care Team if you
  have any questions about their services.
• Alena will be happy to assist you by providing
  additional information, or putting you in touch
  with a member of the team.
• 552-7508 Monday - Friday 9 to 5
• 929-1407 24 hours a day 7 days a week!

12
One question might be How does Palliative Care
Differ From Hospice ?

• Palliative Care and Hospice share a similar
  philosophy a focus on quality of life and the
  whole person/family unit.
• Yet, there are some very distinct differences
  between the two approaches. The following slides
  illustrates some of these differences.

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How does Hospice Differ?

• Hospice helps people who have advanced illness
  and are pursuing non-curative, comfort care.
• Hospice helps people who have made or are
  considering making end of life decisions.
• If the patient is a Medicare patient, criteria
  states the patient has a life expectancy of 6
  months or less. Medicare covers Hospice or
  curative medical care, not both.

14
Contrasting Palliative Care and Hospice

15
Communication is Key!

• The final slides outline key actions for the Unit
  Assistant and/or Nurse when an order for
  Palliative or Hospice is written, including
• how to order a Consultation for Palliative Care
• AND
• the difference between a consultation for
• Hospice and Palliative Care

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The MMH Palliative Care Team

• Our Team members are consulted when a physician
  writes an order for Palliative Care.
• Communication is essential to ensure clarity of
  the physicians order.
• Receipt of the information by key people is
  critical so the order can be carried out in a
  timely manner.

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Palliative Care Hospice Orders

• Ordering Palliative Care differs slightly from
  ordering Hospice but remember
• Both require a physicians order.
• Both must be telephoned to Tidewell at the same
  number
• Call 929-1407 regardless of time, day or night!

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How Do We Take Off a Physician Order for
Palliative Care ?

• The physician writes an order for Palliative
  Care.
• Call Tidewell whenever this order is received.
• Tidewell Hospice Palliative Care is notified at
  929-1407. An answering service covers after
  800 pm.
• Give the patients name, hospital, room number
• Specify a consult for Palliative Care.
• Document who you spoke to, time and date.
• Add Dr. Angsten or Dr. Grandrimo as a consulting
  physician in ClinDoc.
• Enter an order/referral for Case Management into
  Clin Doc and specify Palliative Care consult.

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How do we Take Off a Physician Order for
Hospice ?

• The patients Physician writes an order for
  Hospice
• Call Tidewell whenever this order is received.
• Tidewell Hospice Palliative Care is notified at
  929-1407. An answering service covers after 800
  pm.
• Give the patients name, hospital, room number
• Specify an order for Hospice.
• Document who you spoke to, time and date.
• Enter a Case Management order/referral into
  ClinDoc for Case Management and specify
  Hospice.

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Finally

• In both cases, call Tidewell immediately upon
  receipt of the order for Palliative or Hospice
  consultation.
• 929-1407 regardless of time, day or night
• In both cases, add a Case Management
  order/referral specific to the type of service
  (palliative or hospice).
• When processing an order for Palliative Care, Dr.
  Angsten or Dr. Daniel Grandrimo must be added as
  a consulting physician in ClinDoc.