10/3/2016 PAL L I AT I VE CARE Wha t, Who , Whe re a nd Whe - PDF document

10/3/2016 PAL L I AT I VE CARE • Wha t, Who , Whe re a nd Whe n • Ma ry Gra nt, RN, MS ANP • Co nne c tio ns Nurse Pra c titio ne r • Pa llia tive Ca re Pro g ra m Ore g o n Re g io n WHAT I S T HE DE F I NI T I ON OF PAL L I AT I VE CARE DE F I NI T I ON • T he Ce nte r fo r the Adva nc e me nt o f Pa llia tive Ca re de fine s pa llia tive c a re a s: • Pa llia tive c a re , a lso kno wn a s, pa llia tive me dic ine , is spe c ia lize d me dic a l c a re fo r pe o ple living with se rio us illne sse s. It fo c use s o n pro viding pa tie nts with re lie f fro m the sympto ms a nd stre ss o f a se rio us illne ss---wha te ve r the dia g no sis. T he g o a l is to impro ve q ua lity o f life fo r b o th the pa tie nt a nd the fa mily. • Pa llia tive c a re is pro vide d b y a te a m o f do c to rs, nurse s a nd o the r spe c ia lists who wo rk with the pa tie nt’ s o the r do c to rs to pro vide a nd e xtra la ye r o f suppo rt. Pa llia tive c a re is a ppro pria te a t a ny a g e a nd a t a ny sta g e in a se rio us illne ss, a nd c a n b e pro vide d to g e the r with c ura tive tre a tme nt. 1

10/3/2016 PAL L I AT I VE CARE F ACT S • T he numb e r o f in ho spita l pa llia tive c a re te a ms in the Unite d Sta te s ha s g ro wn d ra ma tic a lly o ve r the pa st d e c a d e . • T he pre va le nc e o f pa llia tive c a re pro g ra ms in U.S. ho spita ls with 50 b e ds o r mo re ha s ne a rly triple d sinc e 2000, re a c hing ne a rly 61% o f a ll ho spita ls o f this size . • Pa llia tive c a re is no w a ke y sta nda rd o f pra c tic e in le a ding he a lth c a re o rg a niza tio ns. PC I N L E ADI NG HE AL T HCARE ORGANI ZAT I ONS • 100% o f the U.S. Ne ws 2014-15 Ho no r Ro ll Ho spita ls • 100% o f the U.S. Ne ws 2014-15 Ho no r Ro ll Child re n’ s Ho spita ls • 100% o f the to p 20 NIH-fund e d me d ic a l sc ho o ls • 97% o f the Co unc il o f T e a c hing Ho spita ls a nd He a lth Syste ms me mb e r o rg a niza tio n • 87% o f the Na tio na l Ca nc e r Institute ’ s d e sig na te d c o mpre he nsive c a nc e r c e nte r WHAT PAL L I AT I VE CARE I S AND I S NOT : • Pa llia tive c a re is no t ho spic e • Pa llia tive c a re is no t a “de a th sq ua d” • Pa llia tive c a re is a multi disc iplina ry a ppro a c h to the pa tie nt’ s c o nditio n a t this po int in the ir jo urne y • Pa llia tive c a re a llo ws the pa tie nt to c o ntinue to g e t tre a tme nt a nd to re turn to the ho spita l fo r se rvic e s if ne e de d. 2

10/3/2016 GOAL S OF BOT H PAT I E NT S AND CL I NI CI ANS • Avo id ina ppro pria te pro lo ng a tio n o f dying • Re lie ving the b urde n o n the fa mily • Ac hie ving a se nse o f c o ntro l • Stre ng the ning re la tio nships with lo ve d o ne s • E nsuring tha t a ll me dic a l o ptio ns a re c o nside re d in c o ntinuing to fig ht a g a inst the d ise a se . PAL L I AT I VE CARE I N PORT L AND ARE A---I NPAT I E NT • It ha s b e e n a n initia tive fo r the Pro vid e nc e He a lth Syste m fo r the pa st 8 ye a rs • In the me tro po lita n a re a , e a c h la rg e Pro vid e nc e Po rtla nd Me d ic a l Ce nte r a nd Pro vid e nc e St Vinc e nt Me d ic a l Ce nte r ,ha s a Pa llia tive c a re te a m b a se d in the ho spita l. It is c o mprise d o f physic ia ns, so c ia l wo rke rs, c ha pla ins a nd nurse s. • T he y g e t re fe rra ls fro m the spe c ia lists, ho spita lists a nd surg e o ns. • In o ur two sma lle r ho spita ls, Pro vid e nc e Willa me tte F a lls a nd Pro vid e nc e Milwa ukie , the re is o ne physic ia n, so c ia l wo rke r a nd c ha pla in who c o ve r tho se fa c ilitie s. • T he re fe rra ls c a n b e to d isc uss g o a ls o f c a re , pa in ma na g e me nt a nd e nd o f life d isc ussio ns fo r the se rio usly ill. PAL L I AT I VE CARE I N T RI -COUNT Y ARE A---OUT PAT I E NT • We ha ve E a stsid e a nd We stsid e te a m tha t a re c o mprise d o f two Nurse Pra c titio ne rs, o ne to two so c ia l wo rke rs a nd a c ha pla in tha t c o ve rs b o th sid e s. • We c o ve r the a re a s tha t Pro vid e nc e Ho me He a lth se rvic e s c o ve r. T ha t inc lud e s a s fa r we st a s St. He le ns, so uth Willa mina , She rid a n, Mc Minnville a nd Wo o d b urn. • We wo rk c lo se ly with the Ho me He a lth Pa llia tive Ca re T e a ms; me e ting we e kly to d o IDG a nd disc uss sha re d pa tie nts. • We me e t with the Ne wb e rg Ho me He a lth Pa llia tive Ca re te a m o nc e a mo nth fo r IDG a nd we a re a va ila b le b y pho ne fo r q ue stio ns. 3

10/3/2016 WHE N I S PAL L I AT I VE CARE APPROPRI AT E WHE RE DO T HE Y RE CE I VE CARE • We in the o utpa tie nt te a m se e pa tie nt’ s in the ir ho me s, a ssiste d living , a d ult fo ste r c a re ho me s a nd me e t pa tie nt’ s a nd fa milie s in me mo ry c a re units. • Whe n we me e t with the pa tie nt we wa nt the fa mily me mb e rs tha t the pa tie nt wo uld wa nt to b e pre se nt. • We like c a re g ive rs to b e pre se nt, a s we ll. • If the y a re g e tting ho me he a lth, we a ppre c ia te the pre se nc e o f tha t te a m a t the c o nsult. • Prima ry c a re pro vid e rs ha ve c o me to the c o nsults, a s we ll. BE F ORE WE ME E T WI T H T HE F AMI L Y • We will lo o k a t the a c tua l re fe rra l to de te rmine why we a re b e ing se nt o ut • We ma y ha ve to re a d the pro vide r’ s no te s o ve r a pe rio d o f time to d e te rmine wha t the y a re a sking us to d o • We lo o k fo r a n a d va nc e d d ire c tive a nd a POL ST • We ma y ne e d to spe a k to the spe c ia list’ s invo lve d a nd a ny o the r c a re te a ms suc h a s Ho me He a lth pro vid e rs. 4

10/3/2016 WHO RE CE I VE S PAL L I AT I VE CARE HOW I S A CONSUL T GE NE RAT E D • Our o ffic e g e ts re fe rra ls fro m prima ry c a re pro vid e rs, spe c ia lists, se lf re fe rra ls fro m fa milie s, skille d fa c ilitie s. • Ma ny o f o ur c o nsults we re pa tie nts tha t ma y ha ve b e e n in the ho spita l a nd the inpa tie nt te a m c o uld n’ t g e t to the m o r tha t the y ha d a c o nsult a nd we a re d o ing a fo llo w up me e ting . • We will se e a ll e nd sta g e o rg a n d ise a se , a ll ne uro lo g ic a l d iso rd e rs; Pa rkinso n’ s, De me ntia ; a ll c a nc e r d ia g no sis, a s we ll. • We d o no t se e pa tie nt’ s with c hro nic pa in unle ss the y ha ve a te rmina l illne ss tha t is invo lve d in the ir d e c line . • T he y d o n’ t ha ve to b e Pro vid e nc e insure d pa tie nts. T he re will b e o ne NP a nd o ne so c ia l wo rke r a t e a c h o ut pa tie nt c o nsult. WHAT T O E XPE CT F ROM A CONSUL T • He lp the pa tie nt g e t a nd unde rsta nd info rma tio n a b o ut the ir illne ss • He lp the pa tie nt c o mmunic a te mo re e ffe c tive ly with the ir pro vide rs a nd fa mily me mb e rs • He lp the pa tie nt ma ke impo rta nt de c isio ns a b o ut the ir he a lth c a re , b a se d o n yo ur pe rso na l va lue s • Give the pa tie nt e xpe rt a dvic e o n pa in a nd sympto m ma na g e me nt • Se rve a s a re so urc e fo r yo ur pro vide rs 5

10/3/2016 WHAT A CONSUL T MAY L OOK L I K E • We g e t se ttle d a nd ma ke sure the pa tie nt is c o mfo rta b le a nd c a n he a r o ur disc ussio n. • We a sk if the y unde rsta nd why we re a re the re ; mo st time s we do a n e xpla na tio n o f o ur se rvic e a nd who a ske d us to me e t with the m. • We ma ke sure tha t e ve ry o ne in the ro o m ha s a n intro duc tio n. • T he first pa rt o f o ur c o nsult is to g e t to kno w the pa tie nt o n a pe rso na l le ve l, no t just wha t is in the ir c ha rt. CONSUL T • We do a sk pe rmissio n to a sk the se q ue stio ns; whe re we re the y b o rn, sib ling s, e duc a tio n, wa r time e xpe rie nc e , ma rrie d a nd ho w the y me t, wha t did the y do fo r wo rk a nd wha t ha ve the y do ne if the y a re re tire d. • T his g ive s us a g o o d ide a o f ho w the ir re c a ll is a nd wha t wa s impo rta nt to the m g o ing thro ug h life . • We the n a sk the pa tie nt a nd we a sk pe rmissio n to a sk the fa mily, “ho w ha s the pa st six mo nths b e e n g o ing ? ” • We a llo w the pa tie nt to re spo nd first a nd the n a sk pe rmissio n to c he c k with the ir fa mily me mb e rs. • We no tic e a nd a c kno wle d g e e mo tio ns CONSUL T • Afte r he a ring fro m e ve ryo ne , we a sk “wha t do yo u kno w a b o ut yo ur illne ss o r wha t ha ve the pro vide rs to ld yo u? ” T his g ive s us a n o ppo rtunity to sha re wha t we kno w a b o ut wha t is g o ing o n with the pa tie nt. • We the n a sk if the y a re ha ving a ny sympto ms tha t we sho uld b e c o nc e rne d a b o ut suc h a s pa in, diffic ulty swa llo wing , na use a , vo miting , we ig ht lo ss, b re a thing , b o we ls a nd b la d d e r, e ne rg y a nd mo o d . If the y a re ha ving sympto ms, wha t a re the y ta king a nd is it he lping . • We a sk ho w the y a re func tio ning ; c a n the y do the ir a c tivitie s o f da ily living ; suc h a s b a thing , dre ssing a nd fe e ding . Ca n the y wa lk with o r witho ut a ssista nc e . 6