somc hospice & palliative care a special kind of caring… a department of southern ohio medical...
TRANSCRIPT
SOMC Hospice& Palliative Care
a special kind of caring…
A Department of Southern Ohio Medical Center
Objectives:
Discuss the philosophy, admission criteria, referral process and services for Hospice and Palliative Care programs
Describe the functions and duties of the Interdisciplinary Team approach
Discuss limited pain and symptom management strategies
Hospice Philosophy To recognize death as a universal
experience To recognize dying as a normal
process To affirm life and discount death
denial To acknowledge that a person is part
of a family unit To provide end of life palliative care –
comfort, care and support services
Hospice Philosophy (cont)
To provide comfort without prolonging life or hastening death
To focus on holistic care To encourage all persons to live fully,
even as death approaches To encircle the family unit with support
and caring through the use of the Interdisciplinary Team
Hospice Admission Criteria
Be willing to accept the hospice philosophy of care and make an informed choice
Have a life expectancy of six months or less, (months instead of years), if the disease runs its expected course
Choose supportive care instead of curative treatment
Admission Criteria (cont)
Have a physician willing to be the primary physician for hospice care
Have a need for supportive care, even if the patient is ambulatory and not home bound
Admission Criteria (cont)
Admission Criteria (cont)
For non-cancer diagnoses, Medicare has agreed upon criteria for determining prognosis – as depicted by the disease categories listed previously
These criteria apply to all non-cancer hospice patients regardless of reimbursement
Referral Process
Anyone can make a referral to hospice When referral is received, a hospice
admissions nurse will follow-up within 24 hours
Hospice nurse will phone the physician for orders to evaluate the patient for hospice appropriateness
Imminent death referrals are followed-up within one hour
The Hospice Team Skilled Nursing –
Provided under the direction of the physician
Weekly visits and as neededProvide comprehensive assessment with
each visitProvide emotional supportFocus on patient/caregiver educationNurses available 24 hours a day, seven
days a weekCoordinate the patient’s individualized Plan
of Care with the IDT
The Hospice Team (cont) Hospice Aides –
Provide care under the direction of the Primary RN
Assist the patient/family in a caregiver role
Provide personal hygieneAssist family members in learning care-
giving skillsVisit 1 – 5 times per week based upon
need
The Hospice Team (cont) Medical Social Work –
Provide special insight into problems created within families as they experience crisis and loss
Provide assistance with legal and financial needs
Assist with community resourcesProvide social and psychosocial counselingAssistance with advance directivesParticipate in the IDT Plan of Care
The Hospice Team (cont)
Spiritual Care –Presence ministryLife reviewSacramental needsContacting patient’s church/personal
clergyEnd of life spiritualitySpecial Services
The Hospice Team (cont) Medical Director –
Certifies and re-certifies patient appropriateness for hospice care, including Face to Face visits as needed
Provides consultative service to the IDT and to the patient’s attending physician regarding patient plan of care
The Hospice Team (cont)
Medical Director – (continued) –Participates in IDT meetingsCovers patient admissions to the
Hospice Center as neededContributes to the patient’s IDT
Comprehensive Care Plan
The Hospice Team (cont)
Volunteer Services – Provide patient visits in the home setting Visit patients in hospital setting Sit with patients Provide respite services for caregivers Light housekeeping Running general errands Delivering supplies, medications, etc Telephone contacts and support Office work, fund raising support Eleventh Hour Team support
The Hospice Team (cont)
Pharmacy consultation Nutrition consultation Physical therapy Occupational therapy Speech therapy Attending Physician Patient and Family
Areas of Expertise
Pain Management Symptom Management
Nurses attend on-going lectures to stay current with evidence based practices
IDT also attends lectures regarding their roles in pain and symptom management
Care Settings
Home Care Acute Inpatient Care Respite Care
Palliative Sedation:
Voluntary election to use medications for the express purpose of relieving refractory pain and/or symptoms in the form of drug induced sleep state.
*Not comparable with euthanasia or physician assisted suicide
Palliative Sedation:
Ethical JustificationIntent: Relief of suffering, as a last
resortOutcome: Patient is made unaware of
suffering through sedation/sleep
Studies show that death is not hastened during this process
Palliative Sedation:
Facts -Sedation may be partial, intermittent or
complete based upon patient/family preference
Not irreversibleIndicated only for refractory symptoms
– when nothing else is workingAppropriate when patient is imminent or
getting close to death
Palliative Sedation:
Reasons for sedation – PainTerminal restlessness/deliriumDyspneaBleedingNausea/vomiting
**Symptoms must be truly refractory
Palliative Sedation:
Drug Classifications – OpioidsBenzodiazepinesAntipsychoticsBarbituratesGeneral anesthetics
• IV route is optimal• Specific doses are less important than the
goal of symptom relief
Palliative Sedation:
Suggested Guidelines – Terminal illness with refractory
symptom(s)DNRCCAll other treatments must have been
exhaustedPsychosocial assessmentSpiritual assessment
Palliative Sedation:
Suggested Guidelines - Second physician opinionNutrition/hydration futility addressedReason(s) well documentedConsideration of a trial of respite
sedation firstUse of a proper sedation scale
Hospice Service Areas
Scioto County Pike County Jackson County
Counties partly covered:LawrenceAdamsRoss
SOMC Hospice Center Home-like atmosphere designed to
provide quality care for hospice patients and families
Not a residential facility – goal of care is short term stay
Visitors welcome 24/7 Patient rooms designed for families to
stay with patients Laundry and kitchen facilities available Menu and room service available
SOMC Hospice Center (cont) Reasons for admission to the center:
Must be an SOMC Hospice PatientAcute stay – pain and/or symptoms unable
to ideally be treated in home settingImminent death – when not optimal for the
patient’s death to occur in the home setting
Respite stay – five day stay, monthly as needed to give caregiver(s) a rest from 24/7 care
Pet Therapy – “Marley”
Staff member who walks on four legs A “People Person” Offers comfort to patients and families Intuitive caring Loves attention
Honorable mention – “Swann”, our first Hospice dog has retired after years of great service
Bereavement Services Designed to help families and loved
ones cope with terminal illness and loss
Emotional support provided free of charge from the time of the patient’s admission to hospice services and up to 13 months after the patient’s death
Individual, adult, child and family counseling upon request
Not limited only to hospice families
Bereavement Services (cont)
Phone calls; Visits; Cards and letters commemorating special dates; Bi-monthly newsletter – “Resolutions”; Educational materials
Memorial Quilt Project Memorial Life Celebration Support groups – different themes All bereavement services are free of charge
Reimbursements
Medicare Medicaid Insurance payors VA Self-pay Indigent Donations/fund raisers
Living With Hope Talk openly and honestly with one another Recognize that death is a part of life Consider each day as full of potential to
be enjoyed as much as possible Realize that life is never perfect – it was
not perfect before illness and will not be perfect after
Use faith and spiritual strengths for support
Living With Hope (cont) See oneself as living with illness
instead of dying from it Enjoy the simple things in life – it is
often these that give life meaning and enjoyment
Include loved ones in the experience by talking about fears, concerns and feelings
Daily private time is a healthy practice Physical pain can be increased with
social, emotional or spiritual pain
Palliative Care Services
Nurses specializing in palliative care provide weekly home visits and more if need is indicated
Hospice Department assists as needed and covers after hours calls and visits
Indicated for patients with a life-limiting illness
Palliative Care Services
Patient must be homebound and have a skilled need
Hospice has partnered with SOMC Home Care for billing purposes
Goal to keep patient out of the hospital Very similar to hospice services in
providing pain and symptom management
Palliative Care Services
Prognosis is not limited to 6 months Can provide curative, life sustaining
care
Palliative Care – Nurse Practitioner Program
Services provided in the patient’s home or homelike setting (SNF; Assisted Living) by a Nurse Practitioner
Patients do not require a skilled need or homebound status
Visits are based on medical necessity – per week, per month, etc.
Palliative Care – Practitioner Program
Can be in addition for the Home Care program or can be independent, based upon patient need
24/7 access to on-call nursing services Does not replace physician – NP will
collaborate with the patient’s physician on-going to determine appropriate interventions
Referrals:
Hospice and Palliative Care
(740) 353-2567 (24/7)
Ext. 2651 (During business hours only)
Questions???