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Medication/Opioids

Medication/Opioids. (20 minutes). 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).

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Medication/Opioids

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  1. Medication/Opioids (20 minutes)

  2. 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

  3. 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.

  4. 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

  5. GPAC/FPON Palliative Care Guidelines Part 2: Pain and Symptom Management (10 minutes)

  6. Pain Management Dyspnea Nausea & Vomiting Constipation Delirium Fatigue & Weakness Depression OPQRSTU mnemonic for assessment Prevention/anticipation of symptom & side-effects Physical exam 7 Sections 6

  7. GPAC/FPON Palliative Care Guidelines: Part 2 Pain Algorithm 7

  8. 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.

  9. Physician care plan templates 9

  10. Care plan templates MOA

  11. 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).

  12. Care plan template - Communication

  13. GPs and MOA to regroup

  14. Develop office approach (10 minutes)

  15. 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.

  16. 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

  17. EMR video • Play EMR video

  18. Planning for Action Period (25 minutes)

  19. Act Plan Study Do 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?

  20. Measurement “Without data, everyone is perfect.” - Dr. Paul Murray

  21. Focus areas for Action Period 2 • 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

  22. 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.

  23. Thank you!

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