Transcript Document

Medication/Opioids
(20 minutes)
1
Good Plans: Manage pain & other symptoms
Fraser Health symptom guidelines: > 20 topics covered
• Extensive literature and peer review (4th edition: April
2009).
• Being reviewed and revised as a provincial document (BC
Learning Centre for Palliative Care).
• http://www.fraserhealth.ca/professionals/hospice_palliative_
care
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Common symptoms: Dyspnea
• Dyspnea present in
95% of pts with COPD
and 75% of patients
with advanced disease
of any cause.
• Despite a good
evidence base many
people with chronic
disease do not receive
opioids for dyspnea
until they are dying.
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Dyspnea management: Includes Opioids
• Meta-analysis:
OPIOIDS lead to statistically significant and clinically
consistent improvement.
• Drug of first choice in management of moderate to
severe dyspnea.
• Can be used for dyspnea in cancer, COPD, CHF,
neurological disorders (e.g. ALS).
• Relief occurs in the absence of significant changes in
blood gases, oxygen saturation.
Jennings: Meta-analysis Thorax 2002
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GPAC/FPON
Palliative Care Guidelines
Part 2:
Pain and Symptom Management
(10 minutes)
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7 Sections
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Pain Management
Dyspnea
Nausea & Vomiting
Constipation
Delirium
Fatigue & Weakness
Depression
• OPQRSTU mnemonic for assessment
• Prevention/anticipation of symptom & side-effects
• Physical exam
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GPAC/FPON
Palliative
Care
Guidelines:
Part 2
Pain
Algorithm
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Use an End of Life Care Plan
End of Life Care Plan Templates.
• Track interventions.
• Track response to treatment.
• Record other providers involved and plan of
care.
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Physician care plan templates
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Care plan
templates
MOA
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Support team-based care
• Establish how patient visits and referral
between team members should be made.
• Advise others on what information is
useful on referral.
• Agree how and when communication
between professionals will occur.
– Establish reliable methods of leaving and
retrieving messages.
• GPs billing for palliative care (reference in
package).
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Care plan template - Communication
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GPs and MOA to regroup
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Develop office approach
(10 minutes)
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Practice approach to care
• Knowing your patient and family.
• Knowing what you plan to do with your
patient and family.
• Communicating patient recognition / registry
and material.
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Office procedures
• Proactive planned recall or house calls near end stage
• Tools that can help communicate within the office
– Huddle Sheet
– Ringed physician specific communication binder
– EMR
• Put copies of the form/information toolkit (e.g. No CPR)
into examination room
• Physician - MOA dyad
• Specific arrangements about how healthcare professional
can get through to you
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EMR video
• Play EMR video
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Planning for Action Period
(25 minutes)
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Model for Improvement
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What changes can we make that
will result in improvement?
Act
Plan
Study
Do
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Measurement
“Without data, everyone is perfect.”
- Dr. Paul Murray
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Focus areas for Action Period 2
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Building upon tests from Action Period 1
Collaborative care
Advanced Care Plans
PPS, ESAS and Pain and Symptom Diary
MOA role in EoL care
Expanding registry and measures
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Where to start: What changes can we make
that will result in an improvement?
• What are you going to do
next Tuesday?
• What is the plan?
• Remember to think about
how you will
measure/track
improvement.
• Record on Action Plan
and report back in 15
min.
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Thank you!
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