Temiskaming Hospital Hospice Palliative Care Presented by: Dr. Don - - PowerPoint PPT Presentation

Presented by: Dr. Don Davies January 31, 2017

Temiskaming Hospital Hospice Palliative Care

• 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

Objectives

Curative or life-prolonging treatment Palliative care

Palliative Care Redefined

Adapted from Cancer Pain Relief and Palliative Care. Technical Report Series 804. Geneva: World Health Organization, 1990

Traditional’ Model of Care (1975 – 2002)

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Palliative Care Redefined

There are 3 typical trajectories that lead to death 1) Sudden Death… Few of us will die this way (accidents, cardiac

• r 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

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Palliative Care Redefined

 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.

HPC – 2002 redefined by CHPCA

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Palliative Care

Is Not… a person, place or program It Is…

• A philosophy or an approach to care
• A clinical specialty with specific skill sets
• A focus on individualized patient centered care

at any stage of the illness using a palliative care approach

Palliative Care Redefined

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Palliative Care Redefined

The Role of Hospice Palliative Care During Illness (Canadian Hospice Palliative Care Association model - 2002)

Care to modify disease Hospice Palliative Care to relieve suffering and/or improve quality

• f life

Focus of Care

Presentation/ Diagnosis

Acute

Time

Chronic Advanced Life-threatening

Individual’s Death

Illness Bereavement

End-of-Life Care

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PSO Rounds Carolyn Taylor

Residential Hospice Beds Capacity Planning in Timiskaming

Timiskaming Population in 2012 1% expected to die within the year Kirkland Lake 12,728 127 Englehart 3,663 37 Temiskaming Shores 16,934 169 Timiskaming -total 33,325 333

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• Hospice Beds Provincial Formula
• 6 beds / 100,000 population
• 6 x 33,325
• 100.000

Residential Hospice Beds Capacity Planning in Timiskaming

Timiskaming –total population 2012 33,325 = 1.99 Hospice Care Beds are needed within Timiskaming

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Rural HPC Co-Location Model

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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

Rural HPC Co-Location Model

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COMMUNITY HOSPICE Kirkland Lake

October 19, 2013 KDH

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COMMUNITY HOSPICE Englehart

October 2014

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Beverly-Ann Boros Hospice Suite

Community Hospice… Temiskaming Shores

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

• See package

Community Referral Form

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.

• See package

In Patient Referral Form

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.

• Wish to continue active/ curative treatment
• Medical or nursing needs whose complexity/
• r 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

Exclusion Criteria

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 1 2 3 4 5 6 7 8 9 10 Worst Possible Pain Not Tired 1 2 3 4 5 6 7 8 9 10 Worst Possible Tiredness Not Nauseated 1 2 3 4 5 6 7 8 9 10 Worst Possible Nausea Not Depressed 1 2 3 4 5 6 7 8 9 10 Worst Possible Depression Not Anxious 1 2 3 4 5 6 7 8 9 10 Worst Possible Anxiety Not Drowsy 1 2 3 4 5 6 7 8 9 10 Worst Possible Drowsiness Best Appetite 1 2 3 4 5 6 7 8 9 10 Worst Possible Appetite Best Feeling of Well-Being 1 2 3 4 5 6 7 8 9 10 Worst Possible Feeling of Well- Being No Shortness of Breath 1 2 3 4 5 6 7 8 9 10 Worst Possible Shortness of Breath Other Problem 1 2 3 4 5 6 7 8 9 10 Patient’s Name: Date: Time: Completed by: Patient / caregiver / Caregiver Assisted

Edmonton Symptom Assessment Scale (ESAS)

• Measures severity of symptom at the time of

assessment / Identifies issues

• Numerical scale – “0-10”

– “0”= symptom absent – “10”= worse possible symptom severity

• Not a complete symptom assessment
• ESAS is one part of holistic clinical assessment

Purpose / Benefits of Using ESAS?

• Standardized screening tool for symptoms
• Used in many sites across Canada, and

internationally (developed Edmonton AB)

• Determines severity of symptom from the

person’s perspective

• Quickly identify issues that are of priority &

concern

• Promotes person directed care &

empowerment

Purpose / Benefits of Using ESAS?

• Provides clinical profile of symptom severity
• ver time
• Promotes effective communication between

providers and across settings

• Provides a simple, valid tool to measure the

effectiveness of interventions

• Excellent audit tool for your organization

Who Completes the ESAS?

• Ideally… patient & family are taught how to

complete the ESAS

• Gold standard: the person with the symptoms

identifies the issues and determines the severity (subjective data)

• If person cognitively impaired, it is completed

by caregiver or health professional (with or without involvement of person depending on level of cognitive impairment)

• If health care provider completing on own,

administer at end of patient contact

– Not as reliable if done by caregiver / objective data

Temiskaming Hospital…. Palliative Care Order Set

Palliative Care Admission Order Set

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Questions???