HITTING THE MARK WITH PALLIATIVE CARE

SC ASSOCIATION FOR HEALTHCARE QUALITY

JULY 10, 2009

The Carolinas Centerfor 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

Palliative care

Hospice 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– 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:– 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 InformationTamra N. West

Director of SC Programs803-791-4220

twest@carolinasendoflifecare.org