☀ SAVE - EFFECTIVE - COMPASSIONATE


SAVE - EFFECTIVE - COMPASSIONATE?
YAPALINDO
 
Drug interactions
and medications assessed
as ‘‘high risk’’
on Beers criteria
have been linked
with hospitalization
and increased mortality
in other populations
such as the elderly
and nursing home residents,
but no association
with anticholinergic medications
specifically has been described
in the palliative care setting.

Apart from the traditional adverse effects
of anticholinergic drugs
such as dry mouth and constipation,
cumulative anticholinergic load
has been associated with
delirium;
falls,
reduced functional status,
and impaired motor performance;
and poor cognitive outcomes
(in particular, in those with prior
cognitive impairment).

https://www.liebertpub.com/doi/full/10.1089/jpm.2019.0407

Subcutaneous hydration (previously known as hypodermoclysis) is a technique used for the subcutaneous administration of large volumes of fluids and electrolytes in order to achieve fluid maintenance or replacement. It is used in patients who are unable to tolerate sufficient oral intake and where intravenous access may be difficult to obtain or sustain, or is inappropriate.

This free online training is designed for the Australian health context, and is available to participants by simply creating an account and logging in. This project is funded by the Australian Government Department of Health and is developed by the Australian Healthcare and Hospitals Association (AHHA), with input from industry and other specialists.

In the PPS, physical performance is measured in 10% decremental levels from fully ambulatory and healthy (100%) to death (0%). These levels are further differentiated by five observable parameters: the degree of ambulation ability to do activities/extent of disease ability to do self care food/fluid intake level of consciousness

End of life is when a person is living with, and impaired by, a fatal condition, even if the trajectory is ambiguous or unknown.

' '

Guidelines Schedule

Worldwide, a number of significant barriers must be overcome to address the unmet need for palliative care:

Pain is one of the most frequent and serious symptoms experienced by patients in need of palliative care. Opioid analgesics are essential for treating the pain associated with many advanced progressive conditions. For example, 80% of patients with AIDS or cancer, and 67% of patients with cardiovascular disease or chronic obstructive pulmonary disease will experience moderate to severe pain at the end of their lives.

Guidelines for the Management at the End of Life
https://sites.google.com/view/management-at-the-end-of-life/home


 Rapid Discharge Guidance

The aim of this guidance document and supporting tools is to facilitate the rapid discharge of persons from hospital who wish to die at home. Below you will find a guidance document, presentation, summary steps and useful documents to allow healthcare teams to plan and enable discharge where possible.

INSPIRE SELF-CARE
Many people living with cancer experience nausea, diarrhea, and other symptoms and side effects from their treatment or disease. For healthcare providers, we offer tools for assessing and managing patients’ symptoms and side effects.

Palliative care is more than just pain relief. It includes addressing the physical, psychosocial and emotional suffering of patients with serious advanced illnesses and supporting family members providing care to a loved one.


Codeine is not generally given as a single agent when used orally as an analgesic, but is usually combined with a non-opioid and recent systematic reviews confirm that the combination of codeine and paracetamol is more effective that paracetamol alone.
http://www.geocities.ws/kaqu/simanpc/8.2%20-%20The%20management%20of%20Pain/8.2.3%20-%20Opioid%20analgesic%20therapy.htm

 

Your Symptoms Matter is a set of tools to help healthcare providers monitor and manage their patients’ symptoms more effectively. These tools can be used regardless of where patients are in the cancer continuum.

MANAGING SYMPTOMS FOR AN ADULT IN THE LAST DAYS OF LIFE

Management of hiccups in palliative care patients
If a patient is in the last few days of life, consideration should be given to using midazolam by subcutaneous infusion to relieve intractable hiccups. Midazolam may also be used while trialling the efficacy of other treatments. Midazolam is commonly used in the terminal phase of patient care—for management of agitation and distress. This general sedation effect was also found to be useful to suppress hiccup reflexes through case reports.
https://spcare.bmj.com/content/bmjspcare/8/1/1.full.pdf

All nursing staff who care for dying patients have a responsibility to ensure they have enough knowledge and skills to manage the key symptoms that may occur in the last few days of life.

THE PALLIATIVE CARE HANDBOOK - 2019

Radiotherapy for the Palliation of Advanced Sarcomas—The Effectiveness of Radiotherapy in Providing Symptomatic Improvement for Advanced Sarcomas in a Single Centre Cohort

Principles of Palliative Care
  • Palliative care incorporates the whole spectrum of care — medical, nursing, psychological, social, cultural and spiritual. A holistic approach, incorporating these wider aspects of care, is good medical practice and in palliative care it is essential.
  • The principles of palliative care might simply be regarded as those of good clinical practice, whatever the patient’s illness, wherever the patient is under care, whatever his / her social status, creed, culture or education.

This resource has been developed for you by the Royal College of Nursing (RCN) and is designed to offer you support in your delivery of appropriate end of life care alongside your existing training.

Patients with palliative performance scale (PPS) levels of 10%, 20%, and 30%
(ie bed bound, needing all care, reduced oral intake and drowsy) have a median survival of 2, 4 and 13 days, respectively,
thus probably making the PPS the most suitable prognostic tool for identifying patients at risk of imminent death.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752241/

The Palliative Performance Scale (PPS), a modification of the Karnofsky Performance Scale, is presented as a new tool for measurement of physical status in palliative care. Its initial uses in Victoria include communication, analysis of home nursing care workload, profiling admissions and discharges to the hospice unit, and, possibly, prognostication. Palliative Performance Scale (PPS): A new tool (PDF Download Available).
Available from: https://www.researchgate.net/

The Hospice and Palliative Nurses Association provides educational opportunities not only to our members, but to all hospice and palliative nurses and members of the nursing team.

PALLIA 10

Through early integration into the care plan of seriously ill people, palliative care improves quality of life for both the patient and the family.

𝑨 𝑮𝑶𝑶𝑫 𝑫𝑬𝑨𝑻𝑯 - 𝑷𝑬𝑹𝑺𝑷𝑬𝑪𝑻𝑰𝑽𝑬𝑺 𝑶𝑭 𝑴𝑼𝑺𝑳𝑰𝑴 𝑷𝑨𝑻𝑰𝑬𝑵𝑻𝑺 𝑨𝑵𝑫 𝑯𝑬𝑨𝑳𝑻𝑯 𝑪𝑨𝑹𝑬 𝑷𝑹𝑶𝑽𝑰𝑫𝑬𝑹𝑺

Our goal is to improve the quality of life for patients and families facing serious illnesses through education of multi-disciplinary doctors, nurses,psychologists, social workers and other allied health personnel. Developed by Stanford eCampus this FREE training portal features learning modules, resources and training materials from internationally recognized leaders in the field of Hospice and Palliative Medicine.

Each year, 40 million people are in need of palliative care. Only 14% of people needing palliative care at the end of life currently receive it. Palliative care is an essential component of comprehensive health services for NCDs.

The Dana-Farber Cancer Institute/ Brigham and Women’s Hospital Pain Management Tables and Guidelines (Pink Book) has been in use by DFCI/BWH clinicians since 1998. Widely used by the Harvard Interprofessional Palliative Care fellows and internal medicine house staff at Brigham and Women’s Hospital, the Pink Book contains useful opioid conversion tables, medication charts, and clinical pearls in the clinical management of pain.

Palliative care education and training collaborative

The Guide to Children’s Palliative Care is an essential resource for all those with an interest in planning, commissioning and delivering services and care for babies, children and young people with life-limiting and life-threatening conditions, and their families.

  • The General Medical Council defines approaching the end of life as when a person is likely to die within the next 12 months. This timeframe provides a guide as to when people might be identified as approaching the end of life. 
  • For some conditions, the trajectory may require identification and subsequent planning to happen earlier. 
  • For other conditions, it may not be possible to identify people until nearer the time of death. Identification should take place with sufficient time to enable provision of high-quality end of life planning, care and support in accordance with the person's needs and preferences. 
  • Identification will need to be considered on an individual basis.
https://www.nice.org.uk/guidance/qs13/chapter/Quality-statement-1-Identification

Among the most important projects is “3.g.i.”, which aims to integrate palliative care into the Patient-Centered Medical Home Model. CCB believes that improvement in the practice of primary palliative care—interventions delivered through primary care that aim to reduce the burden of illness associated with any type of serious chronic illness—is essential to advancing the PPS transformational agenda.

PENNINE LANCASHIRE PALLIATIVE AND END OF LIFE CARE MODEL



PAIN IS MULTIDIMENSIONAL
    
   
    Pain is one of the most frequent
    and serious symptoms
    experienced by adults and children
    in need of palliative care.

    For example,
    80% of patients with AIDS or cancer,
    and 67% of patients with cardiovascular disease
    or chronic obstructive pulmonary disease
    will experience moderate
    to severe pain at the end of their lives.

    Pain is multidimensional:
    Cicely Saunders introduced
    the concept of “total pain”,
    where pain includes physical,
    emotional, psychosocial,
    and spiritual dimensions.
 
 
THE FIVE DYSFUNCTIONS OF A TEAM
  1. Absence of trust — unwilling to be vulnerable within the group
  2. Fear of conflict — seeking artificial harmony over constructive passionate debate
  3. Lack of commitment — feigning buy-in for group decisions creates ambiguity throughout the organization
  4. Avoidance of accountability — ducking the responsibility to call peers on counterproductive behavior which sets low standards
  5. Inattention to results — focusing on personal success, status and ego before team success

The Five Dysfunctions of a Team
Author Patrick Lencioni
Published 2002 (Jossey-Bass)
https://en.wikipedia.org/wiki/The_Five_Dysfunctions_of_a_Team
 
 
 
Domains of the cancer care continuum with examples of activities in each domain. The top arrow identifies components of high-quality cancer care that should span the cancer care continuum from diagnosis through end-of-life care. The bottom arrow identifies three overlapping phases of cancer care, which are a way of conceptualizing the portion of the cancer care continuum that is the focus of this report.  
 

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