Provide palliative and hospice care by an interdisciplinary team of skilled palliative care professionals, including, for example, physicians, nurses, social workers, pharmacists, spiritual care counselors, and others who collaborate with primary healthcare professional(s).
- 1. Provide access to palliative and hospice care that is responsive to the patient and family 24 hours a day, 7 days a week.
- 2. Provide continuing education to all healthcare professionals on the domains of palliative care and hospice care.
- 3. Provide adequate training and clinical support to assure that professional staff is confident in their ability to provide palliative care for patients.
- 4. Hospice care and specialized palliative care professionals should be appropriately trained, credentialed, and/or certified in their area of expertise.
- 5. Formulate, utilize, and regularly review a timely care plan based on a comprehensive interdisciplinary assessment of the values, preferences, goals, and needs of the patient and family and, to the extent that existing privacy laws permit, ensure that the plan is broadly disseminated, both internally and externally, to all professionals involved in the patient's care.
- 6. Ensure that upon transfer between healthcare settings, there is timely and thorough communication of the patient's goals, preferences, values, and clinical information so that continuity of care and seamless follow-up are assured.
- 7. Healthcare professionals should present hospice as an option to all patients and families when death within a year would not be surprising and should reintroduce the hospice option as the patient declines.
- 8. Patients and caregivers should be asked by palliative and hospice care programs to assess physicians'/healthcare professionals' ability to discuss hospice as an option.
- 9. Enable patients to make informed decisions about their care by educating them on the process of their disease, prognosis, and the benefits and burdens of potential interventions.
- 10. Provide education and support to families and unlicensed caregivers based on the patient's individualized care plan to assure safe and appropriate care for the patient.
- 11. Measure and document pain, dyspnea, constipation, and other symptoms using available standardized scales.
- 12. Assess and manage symptoms and side effects in a timely, safe, and effective manner to a level that is acceptable to the patient and family.
- 13. Measure and document anxiety, depression, delirium, behavioral disturbances, and other common psychological symptoms using available standardized scales.
- 14. Manage anxiety, depression, delirium, behavioral disturbances, and other common psychological symptoms in a timely, safe, and effective manner to a level that is acceptable to the patient and family.
- 15. Assess and manage the psychological reactions of patients and families (including stress, anticipatory grief, and coping) in a regular, ongoing fashion in order to address emotional and functional impairment and loss.
- 16. Develop and offer a grief and bereavement care plan to provide services to patients and families prior to and for at least 13 months after the death of the patient.
- 17. Conduct regular patient and family care conferences with physicians and other appropriate members of the interdisciplinary team to provide information, to discuss goals of care, disease prognosis, and advance care planning, and to offer support.
- 18. Develop and implement a comprehensive social care plan that addresses the social, practical, and legal needs of the patient and caregivers, including but not limited to relationships, communication, existing social and cultural networks, decision making, work and school settings, finances, sexuality/intimacy, caregiver availability/stress, and access to medicines and equipment.
- 19. Develop and document a plan based on an assessment of religious, spiritual, and existential concerns using a structured instrument, and integrate the information obtained from the assessment into the palliative care plan.
- 20. Provide information about the availability of spiritual care services, and make spiritual care available either through organizational spiritual care counseling or through the patient's own clergy relationships.
- 21. Specialized palliative and hospice care teams should include spiritual care professionals appropriately trained and certified in palliative care.
- 22. Specialized palliative and hospice spiritual care professionals should build partnerships with community clergy and provide education and counseling related to end-of-life care.
- 23. Incorporate cultural assessment as a component of comprehensive palliative and hospice care assessment, including but not limited to locus of decision making, preferences regarding disclosure of information, truth telling and decision making, dietary preferences, language, family communication, desire for support measures such as palliative therapies and complementary and alternative medicine, perspectives on death, suffering, and grieving, and funeral/burial rituals.
- 24. Provide professional interpreter services and culturally sensitive materials in the patient's and family's preferred language.
- 25. Recognize and document the transition to the active dying phase, and communicate to the patient, family, and staff the expectation of imminent death.
- 26. Educate the family on a timely basis regarding the signs and symptoms of imminent death in an age-appropriate, developmentally appropriate, and culturally appropriate manner.
- 27. As part of the ongoing care planning process, routinely ascertain and document patient and family wishes about the care setting for the site of death, and fulfill patient and family preferences when possible.
- 28. Provide adequate dosage of analgesics and sedatives as appropriate to achieve patient comfort during the active dying phase, and address concerns and fears about using narcotics and of analgesics hastening death.
- 29. Treat the body after death with respect according to the cultural and religious practices of the family and in accordance with local law.
- 30. Facilitate effective grieving by implementing in a timely manner a bereavement care plan after the patient's death, when the family remains the focus of care.
- 31. Document the designated surrogate/decision maker in accordance with state law for every patient in primary, acute, and long-term care and in palliative and hospice care.
- 32. Document the patient/surrogate preferences for goals of care, treatment options, and setting of care at first assessment and at frequent intervals as conditions change.
- 33. Convert the patient treatment goals into medical orders, and ensure that the information is transferable and applicable across care settings, including long-term care, emergency medical services, and hospital care, through a program such as the Physician Orders for Life-Sustaining Treatment (POLST) program.
- 34. Make advance directives and surrogacy designations available across care settings, while protecting patient privacy and adherence to HIPAA regulations, for example, by using Internet-based registries or electronic personal health records.
- 35. Develop healthcare and community collaborations to promote advance care planning and the completion of advance directives for all individuals, for example, the Respecting Choices and Community Conversations on Compassionate Care programs.
- 36. Establish or have access to ethics committees or ethics consultation across care settings to address ethical conflicts at the end of life.
- 37. For minors with decision making capacity, document the child's views and preferences for medical care, including assent for treatment, and give them appropriate weight in decision making. Make appropriate professional staff members available to both the child and the adult decision maker for consultation and intervention when the child's wishes differ from those of the adult decision maker.
MOUTH PROBLEMS
Good mouth care is essential to the wellbeing of debilitated patients. Although mouth problems are very common (up to 90% of patients in some surveys), it is often a neglected area of care.
Diagnosis
- Thorough inspection of the oral cavity is required – use a torch.
☛ Note the state of the lips, teeth/dentures (remove the dentures for examination), mucous membranes and tongue
☛ Note the type and volume of saliva
- Assess nutritional status
☛ Consider the quality of diet and adequacy of fluid intake
- Assess mental state
☛ This will determine the patient’s ability and willingness to participate in their care
REMEMBER THE FIVE PRIORTIES FOR THE CARE OF DYING PATIENTS:
- ☛ 1. The possibility (that a person may die within the next few days or hours) is recognised and communicated clearly, decisions made and actions taken in accordance with the person’s needs and wishes, and these are regularly reviewed and decisions revised accordingly.
- ☛ 2. Sensitive communication takes place between staff and the dying person, and those identified as important to them.
- ☛ 3. The dying person, and those identified as important to them, are involved in decisions about treatment and care to the extent that the dying person wants.
- ☛ 4. The needs of families and others identified as important to the dying person are actively explored, respected and met as far as possible.
- ☛ 5. An individual plan of care, which includes food and drink, symptom control and psychological, social and spiritual support, is agreed, co-ordinated and delivered with compassion.
A National Framework and Preferred Practices for Palliative and Hospice Care Quality
https://bit.ly/PreferredPracticesPC
FICA Recommendations
We recommend the following for healthcare providers taking a patient's spiritual history:
- Consider spirituality as a potentiality important component of every patient's physical well being and mental health.
- Address spirituality at each complete physical examination and continue addressing it at follow-up visits if appropriate. In patient care, spirituality is an ongoing issue.
- Respect a patient's privacy regarding spiritual beliefs; don't impose your beliefs on others.
- Make referrals to chaplains, spiritual directors, or community resources as appropriate.
- Be aware that your own spiritual beliefs will help you personally and will overflow in your encounters with those for whom you care to make the doctor-patient encounter a more humanistic one.
People are ‘approaching the end of life’
if they are likely to die within the next 12 months. This definition is
used by many national organisations. It includes people whose death is
imminent (expected within a few hours or days) and those with:
- advanced, progressive, incurable conditions
- general frailty and coexisting conditions that mean they are expected to die within 12 months
- existing conditions if they are at risk of dying from a sudden acute crisis in their condition
- life-threatening acute conditions caused by sudden catastrophic events.
It should, however, also be recognised that many people can
benefit from end of life and palliative care before the last 12 months
of their life. For example, it is particularly important that people
with dementia and other conditions which affect capacity are given the
opportunity to plan ahead long before the last year of life.
Where we refer to people “at the end of life” we mean people who are imminently dying and might be in the last few hours or days of life.
https://www.dyingmatters.org/sites/default/files/user/10Questions.pdf
- stable,
- unstable,
- deteriorating,
- terminal, ,
- bereavement
Symptoms:
☛ Pain
☛ Nausea/vomiting,
☛ anorexia,
☛ itch/irritation,
☛ constipation/diarrhoea,
☛ wound/ulcer,
☛ dysphagia,
☛ incontinence,
☛ weakness/fatigue,
☛ oedema,
☛ dyspnoea,
☛ confusion/delirium.
Psychological/Spiritual:
☛ Anxiety/fear,
☛ anger,
☛ unrealistic goals,
☛ agitation,
☛ request to die,
☛ depression/sadness,
☛ confusion.
Family/Carer:
☛ Denial,
☛ care giver fatigue,
☛ unrealistic goals,
☛ anger,
☛ difficult communication
☛ sensory impairment,
☛ financial,
☛ family/carer conflict,
☛ legal,
☛ family/carer anxiety,
☛ accommodation,
☛ cultural.
https://apps.hnehealth.nsw.gov.au/hapcn/assets/resource/PC%20Clinical%20Assessment%20Tools.pdf
THE TRAJECTORY OF HEART FAILURE
The trajectory of heart failure is comparable to clinical populations with other forms of progressive organ failure such as chronic obstructive pulmonary disease and even to some cancers. However, the course of heart failure is exceptional in its unpredictability, and for an individual patient, no specific trajectory can be reliably anticipated.
Okay kan, Bro!
