Transcript Improving Advance Care Planning

HITTING THE MARK WITH
PALLIATIVE CARE
SC ASSOCIATION FOR
HEALTHCARE QUALITY
JULY 10, 2009
The Carolinas Center
for Hospice and End of Life Care
• Two State Association
• Technical Assistance and Support for
hospice providers
• Palliative Care Network
• End of Life Care Initiatives
• “Helping every community live & die well”
The End of Life Care Umbrella
Advance care planning
Hospice care
Palliative care
Bereavement care
End of Life Care
A continuum of care
throughout our life span that
aims to promote and improve
quality of living and dying
How ACP fits into EOLC
All Hospice Care is Palliative Care,
but…
NOT ALL PALLIATIVE CARE
IS HOSPICE
The Focus of Palliative Care
“…to promote optimal functioning with the
relief of suffering for patients facing
serious life threatening or debilitating
illness and support for the best quality of
life for both patients and their families.”
National Consensus Project: Clinical Practice
Guidelines for Quality Palliative Care, NHPCO, 2009
The National Consensus Project
• 2001 –NHPCO, CAPC, AAHPM,HPNA and Last Acts set forth to build
consensus around the definition, philosophy and principles of palliative care.
Published “Clinical Practice Guidelines for Quality Palliative Care”
• 2004 – Guidelines revised.
• 2006 – NQF (The National Quality Forum) accepted and endorsed the
Guidelines in their document “A Framework for Palliative and Hospice Care
Quality Measurement and Reporting”
• 2009 – Second edition of Guidelines released
Defining “Palliative Care”
Patient and family centered care that optimizes
quality of life by anticipating, preventing, and
treating suffering. Palliative care throughout the
continuum of illness involves addressing
physical, intellectual, emotional, social, and
spiritual needs and to facilitate patient
autonomy, access to information and choice.
CMS Federal Register, 2008
Defining “Palliative Care”
Palliative care is an approach that improves the
quality of life of patients and their families
facing the problems associated with life
threatening illness, through the prevention
and relief of suffering by means of early
identification and impeccable assessment and
treatment of pain and other problems,
physical, psychosocial, and spiritual.
World Health Organization
Defining “Palliative Care”
Palliative care is the medical specialty focused
on relief of the pain and other symptoms of
serious, life-threatening illness. The goal is to
improve quality of life for patients and their
families. Palliative care is appropriate at any
point in an illness. It can be provided at the
same time as curative treatment.
Center to Advance Palliative Care
-OR• “Hospice Upstream”
• “Supportive Care”
• “Comfort Care”
Consensus
• Appropriate for all patients, all ages with a
variety of illnesses, conditions or injuries
• Care is focused on the patient and family
• Should begin at the time of diagnosis and
continues through cure or until death and into
family bereavement period
• Is comprehensive
• Interdisciplinary
Consensus
• Attentive to relief of suffering
• Effective communication skills are necessary
• Skill and competency in care of the dying and
bereaved is required
• Continuity of care across settings is essential
• Accessible
AND…
Committed to quality assessment and
performance improvement and evaluation of
outcomes
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Timely
Patient-centered
Beneficial and effective
Accessible and equitable
Knowledge and evidence-based
Efficient and designed to meet the actual needs of the
patient
– Safe
SOUND FAMILIAR?????
Why Should Hospitals Provide
Palliative Care?
• Expand the care continuum
• Improve quality of care for patients and
their families
• Appropriately utilize all resources
• Reduce costs
• It’s the right thing to do
National Quality Forum Preferred
Practices for Palliative Care
• 38 preferred practices/standards in 8 domains:
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Processes and Structure of Care
Physical Aspects of Care
Psychological and Psychiatric Aspects of Care
Social Aspects of Care
Spiritual, Religious, and Existential Aspects of Care
Cultural Aspects of Care
Care of the Imminently Dying Patient
Ethical and Legal Aspects of Care
Safe – avoid injury from care that is
intended to help
• Provide adequate training to staff
• Provide education and support to families
• Assess and manage symptoms and side
effects
• Provide adequate dosages of medications
Effective – match care to science,
avoid underuse of effective care and
overuse of ineffective care
• PC Professionals should be trained,
credentialed or certified in their area of
expertise
• Provide continuing education to all members
of the interdisciplinary team
• Encourage collaboration between PC
professionals and primary healthcare
providers
• Promote ACP
Patient-centered – honor the
individual and respect choice
• Formulate a comprehensive care plan
based on the goals of care
• Ensure that goals and preferences are
communicated upon transfer between care
settings
• Incorporate cultural aspects in assessment
and care
• Routinely ascertain and document patient
and family choices/preferences throughout
the course of care
Timely –prompt attention benefits
both the patient and family
• Provide access to palliative care services 24/7
• Assess and manage symptoms and side
effects in a timely manner
• Offer bereavement services prior to and after
death
• Formulate and regularly review a timely care
plan
Efficient – reduce waste
• Conduct care conferences including all
members of the care team
• Constantly assess the needs of the needs of
the patient and family
• Develop collaborative relationships for timely
transfers and care
• Promote advance care planning
Equitable – race, ethnicity, gender,
and income should not prevent care
• Palliative care should be offered as
needed
• Choices and preferences should not
influence access to care
• Provide professional interpreter
services if needed
• Utilize educational materials which
are culturally sensitive and in the
patient/family’s preferred language
For More Information
Tamra N. West
Director of SC Programs
803-791-4220
[email protected]