Temiskaming Hospital Hospice Palliative Care Presented by: Dr. Don Davies January 31, 2017
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
Palliative Care Redefined Traditional ’ Model of Care (1975 – 2002) Curative or life-prolonging treatment Palliative care Adapted from Cancer Pain Relief and Palliative Care. Technical Report Series 804. Geneva: World Health Organization, 1990 3
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
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
Palliative Care Redefined Palliative Care Is Not… a person, place or program It Is… o A philosophy or an approach to care o A clinical specialty with specific skill sets o A focus on individualized patient centered care at any stage of the illness using a palliative care approach 6
Palliative Care Redefined The Role of Hospice Palliative Care During Illness (Canadian Hospice Palliative Care Association model - 2002 ) Care to modify disease Focus of Care Hospice Palliative Care to relieve suffering and/or improve quality of life Time Presentation/ Diagnosis Individual’s Death Illness Bereavement Acute Chronic Advanced Life-threatening End-of-Life Care 7
PSO Rounds Carolyn Taylor
Residential Hospice Beds Capacity Planning in Timiskaming 1% expected to die Timiskaming Population in 2012 within the year Kirkland Lake 12,728 127 Englehart 3,663 37 Temiskaming Shores 16,934 169 Timiskaming -total 33,325 333 9
Residential Hospice Beds Capacity Planning in Timiskaming Timiskaming – total population 2012 33,325 • Hospice Beds Provincial Formula • 6 beds / 100,000 population • 6 x 33,325 • 100.000 = 1.99 Hospice Care Beds are needed within Timiskaming 10
Rural HPC Co-Location Model 11
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
COMMUNITY HOSPICE Kirkland Lake October 19, 2013 KDH 13
COMMUNITY HOSPICE Englehart October 2014 14
Community Hospice… Temiskaming Shores Beverly-Ann Boros Hospice Suite
Temiskaming Shores Hospice… January 2017
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
Community Referral Form • See package
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 .
In Patient Referral Form • See package
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.
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.
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
Palliative Performance Scale (PPS)
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%)
Developed by Victoria Hospice Society
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
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
Example #1 of PPS Assignment PPS score 70%
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
Example #2 of PPS Assignment PPS score 50%
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
Example #3 of PPS Assignment PPS score 40%
Palliative Prognostic Index (PPI)
The Edmonton Symptom Assessment Scale (ESAS) No pain Worst possible pain 0 1 2 3 4 5 6 7 8 9 10
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)
Edmonton System Assessment Scale (ESAS) No Pain 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Pain Not Tired 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Tiredness Not Nauseated 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Nausea Not Depressed 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Depression Not Anxious 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Anxiety Not Drowsy 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Drowsiness Best Appetite 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Appetite Worst Possible Feeling of Well- Best Feeling of Well-Being 0 1 2 3 4 5 6 7 8 9 10 Being Worst Possible Shortness of No Shortness of Breath 0 1 2 3 4 5 6 7 8 9 10 Breath Other Problem 0 1 2 3 4 5 6 7 8 9 10 Patient ’ s Name: Date: Time: Completed by: Patient / caregiver / Caregiver Assisted
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