WRHA Palliative Care ProgramFebruary 2013 Lori Embleton, Program Director Mike Harlos, Medical Director
Palliative Care Program Two streams of service delivery: • Registration on Program • Consultative Services
Registration on Program Patients can be “registered” on the Palliative Care Program if they meet program criteria: Prognosis of less than 6 months No longer receiving aggressive treatment which requires on-going monitoring for and treatment of serious complications Have chosen a comfort-focused approach including a decision to decline attempted resuscitation
Registration on Program Once registered with the program, patients are eligible for: Case management through Palliative Care Coordinator Access to Community Palliative Care Nursing 24/7 Palliative Care Nurses have access to Palliative Care Physician Admission to Palliative Care Units (PCU) and Hospice – if bed available Enrollment on Provincial Palliative Care Drug Access Program
When to Register a Patient on Palliative Care Program • Patients are considering going home from acute care • Need to plan for services to be in place • Patients being transferred to Long Term Care Setting
How to Register a Patient on PC Program • Complete the “Application for Registration” form • 2 page form • “completed” forms can be processed more quickly • Completed forms are reviewed by PC coordinator • Accepts on to Program • Rejects application – all reviewed by Manager, Program Director or Medical Director
Acute Palliative Care Units (PCU) • Admission to PCU for symptom issues • Physical symptoms • Psycho-social distress • Caregiver distress • Admissions managed centrally by PC program staff • Bed management guidelines
Acute Palliative Care Units St. Boniface Hospital • 15 bed unit • Access to tertiary care services Riverview Health Centre • 30 bed unit (2 beds currently closed) • Long term care facility
Acute Palliative Care Units Once symptoms are controlled, actively discharge to appropriate site • Approximately 75% of patients die on PC unit • Approximately 20% of patients are discharged home from Palliative Care Units • Lack of care options if home not possible • PCH • Chronic Care • Hospice
Hospice settings in WRHA • Grace Hospice • 12 beds in stand alone facility near Grace hospital • RN staffing 24/7 • Limitations in care that can be provided
Hospice settings in WRHA • Jocelyn House • 4 beds in split-level home in St. Vital • RN staffing 4 hours a day – 5 days a week • HCA provide care 24/7
Hospice Hospice is appropriate when: • Symptoms well controlled • Care needs are not complex • Prognosis of 1 – 3 months • Patients cannot or do not wish to be cared for in the community
Care at Home • Majority of patients on Palliative Care program are in the community • Palliative patients in community have same service limitations as all Home Care clients • HCA and PSW services provided by Home Care Program • Families/caregivers must be very involved in providing care
Community Teams: • Community Nurses • CNS • MD • Coordinator • Psychosocial
Inter-professional Community Model • Implementing EMR • Will allow all members of Palliative Care team in community to chart on one charting system • Will improve information sharing and communication between primary care providers (using EMR) and palliative care providers
Consultative Services Available to anyone with a life limiting illness in any care setting for symptom management, psycho-social support or assistance with discharge planning Consultation services are provided by inter-professional team members including: Palliative Care Physician Palliative Care Clinical Nurse Specialist Psycho-social Support Specialist
When should Palliative Care be consulted? • Assistance with symptom issues • Managing Physical symptoms • MD to MD consults for advice 24/7 • Psycho-social • Assistance with care planning • What might care team expect as patient nears end of life? • Will oral route be available? • Could symptoms escalate?
When should Palliative Care be consulted? • Goals of care are not clear • Discrepancy between patient, family and/or members of care team with plan of care • Discharge to community or LTC is anticipated • Does patient need to be or are they currently “registered” on Palliative Care program? • Would it be appropriate for Palliative Care nurse to see the patient in the community?
What information is needed on consult? • Main reason for consult • What is the main symptom issue? • Urgency of consult • Is the physician aware of the consult?
How to contact Palliative Care Program One number to call if you have questions or need a consultation during business hours: 204-237-2400 Do not page Palliative Care team members directly or leave messages regarding consults on their office phones.
How to contact Palliative Care Program Physician to physician consultation available 24 hours a day – 7 days a week: 204 – 237-2053
Consult Service Community Palliative Nursing • Case Coordinator • Admission Eligibility • Medication Coverage • comfort-focused • prognosis “6 mo. or less” • some treatment limitations(DNAR, no TPN, no chemoTx with high adverse effects • aggressive, often toxic treatment focused on cure or life-prolonging disease modification Diagnosis of Life-Limiting Illness Transitioning to Palliative Palliative
Resources Formal Program Palliative Care as a philosophy of care Increase capacity through education, advocacy, partnerships