Updates to palliative care guidelines suggest patient care improvements

IntroductionAt the early epicentre of the COVID-19 crisis in the USA, our institution saw a surge in the demand for inpatient consultations for areas impacted by COVID-19 (eg, infectious diseases, nephrology, palliative care) and shortages in personal protective equipment (PPE). We aimed to provide timely specialist input for consult requests during the COVID-19 pandemic by implementing an Inpatient eConsult Programme.MethodsWe used the reach, effectiveness, adoption, implementation and maintenance implementation science framework and run chart analysis to evaluate the reach, adoption and maintenance of the Inpatient eConsult Programme compared with traditional in-person consults. We solicited qualitative feedback from frontline physicians and specialists for programme improvements.ResultsDuring the study period, there were 46 available in-person consult orders and 21 new eConsult orders. At the peak of utilisation, 42% of all consult requests were eConsults, and by the end of the study period, utilisation fell to 20%. Qualitative feedback revealed subspecialties best suited for eConsults (infectious diseases, nephrology, haematology, endocrinology) and influenced improvements to the ordering workflow, documentation, billing and education regarding use.DiscussionWhen offered inpatient eConsult requests as an alternative to in-person consults in the context of a surge in patients with COVID-19, frontline physicians used eConsult requests and decreased use of in-person consults. As the demand for consults decreased and PPE shortages were no longer a major concern, eConsult utilisation decreased, revealing a preference for in-person consultations when possible.ConclusionsLessons learnt can be used to develop and implement inpatient eConsults to meet context-specific challenges at other institutions.

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SENTIMENTOS DE ENFERMEIROS NA ASSISTÊNCIA AO PACIENTE EM CUIDADOS PALIATIVOS: UMA REVISÃO INTEGRATIVA / NURSES FEELINGS IN PATIENT CARE IN PALLIATIVE CARE: AN INTEGRATIVE REVIEW

Brazilian Journal of Development ◽

10.34117/bjdv6n8-715 ◽

2020 ◽

Vol 6 (8) ◽

pp. 63874-63890

Author(s):

Ana Paula Ribeiro de Oliveira ◽

Lívia Pereira Ferreira ◽

Alexander de Quadros ◽

Morgana Thais Carollo Fernandes ◽

Amanda Pereira Ferreira Dellanhese

Keyword(s):

Palliative Care ◽

Patient Care ◽

Integrative Review

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Assessing Palliative Care Content in Dementia Care Guidelines: A Systematic Review

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2016.10.368 ◽

2017 ◽

Vol 53 (4) ◽

pp. 804-813 ◽

Cited By ~ 15

Author(s):

Pamela Durepos ◽

Abigail Wickson-Griffiths ◽

Afeez Abiola Hazzan ◽

Sharon Kaasalainen ◽

Vasilia Vastis ◽

...

Keyword(s):

Systematic Review ◽

Palliative Care ◽

Dementia Care ◽

Care Guidelines

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Palliative Care: Essential Concepts in the Education of Health Professionals

Journal of Palliative Care ◽

10.1177/082585978700200205 ◽

1987 ◽

Vol 2 (2) ◽

pp. 18-23 ◽

Cited By ~ 1

Author(s):

Dorothy Brockopp

Keyword(s):

Health Care ◽

Palliative Care ◽

Patient Care ◽

Health Care System ◽

Health Professionals ◽

Basic Concept ◽

Professional Community ◽

Multidisciplinary Nature ◽

Clear Identification ◽

Successful Integration

The successful integration of palliative care with the health care system may require a concentrated effort on the part of the professional community to clearly identify those concepts that form the basis for the model. The lack of a clear identification both of those concepts viewed by the various disciplines as forming the model, or basis of palliative care, and of the areas of conflict within the model, can lead to a variety of problems. Specific problems that can occur, as both formal and informal attempts are made to convey information about palliative care, include a) emphasizing one part of the model without providing an overview, b) presenting a portion of a given concept, and c) presenting one side of a conflict around a basic concept. The lack of a clearly delineated model of palliative care may be the result of the multidisciplinary nature of this particular approach to patient care. Each discipline has tended to emphasize those ideas that best represent that particular profession. This paper attempts to extract and describe from the literature those concepts that are emphasized, across disciplines, as essential to the provision of palliative care. Conflicts related to the essential concepts are also described.

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Impact of Physician Attire on Perception of Patient Care is Different for Patients and Family Members on an Inpatient Palliative Care Ward

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.08.061 ◽

2020 ◽

Vol 231 (4) ◽

pp. e23

Author(s):

Atsushi Shimizu ◽

Mitsue Takeuchi ◽

Fumio Kurosaki ◽

Kaichiro Tamba ◽

Naohiro Sata ◽

...

Keyword(s):

Palliative Care ◽

Patient Care ◽

Family Members ◽

Care Ward

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Palliative Care in a Death-Denying Culture: Exploring Barriers to Timely Palliative Efforts for Heart Failure Patients in the Primary Care Setting

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120920545 ◽

2020 ◽

Vol 38 (1) ◽

pp. 77-83 ◽

Cited By ~ 2

Author(s):

Rebecca M. Crimmins ◽

Lydia Elliott ◽

Darren T. Absher

Keyword(s):

Heart Failure ◽

Primary Care ◽

Palliative Care ◽

Patient Care ◽

Care Setting ◽

Primary Care Setting ◽

Primary Care Providers ◽

Cochrane Library ◽

Care Providers ◽

Communication Time

Context: Heart failure (HF) is a complex, life-limiting disease that is prevalent and burdensome. All major cardiology societies and international clinical practice guidelines recommend the integration of palliative care (PC) interventions alongside usual HF management. Objectives: The purpose of this review of the literature was to evaluate the various barriers to the early initiation of PC for HF patients in the primary care setting. Methods: An integrative literature review was conducted in order to assess and incorporate the diverse sources of literature available. An EBSCO search identified relevant articles in the following databases: Medline complete, Academic Search Premier, CINAHL, PsycINFO, Cochrane Library, and SocINDEX. The search was limited to full text, peer reviewed, English only, and published between 2010 and 2019. Results: Barriers to the integration of PC for HF patients include poor communication between provider/patient and interdisciplinary providers, the misperception and miseducation of what PC is and how it can be incorporated into patient care, the unpredictable disease trajectory of HF, and the limited time allowed for patient care in the primary care setting. Conclusion: The results of this review highlight a lack of communication, time, and knowledge as barriers to delivering PC. Primary care providers caring for patients with HF need to establish an Annual Heart Failure Review to meticulously evaluate symptoms and allow the time for communication involving prognosis, utilize a PC referral screening tool such as the Needs Assessment Tool: Progressive Disease-Heart Failure, and thoroughly understand the benefits and appropriate integration of PC.

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Use of Standardized Assessment Tools to Improve the Effectiveness of Palliative Care Rounds

Journal of Palliative Care ◽

10.1177/0825859717740051 ◽

2017 ◽

Vol 32 (3-4) ◽

pp. 134-140 ◽

Cited By ~ 1

Author(s):

Donna Spaner ◽

Valerie B. Caraiscos ◽

Christina Muystra ◽

Margaret Lynn Furman ◽

Jodi Zaltz-Dubin ◽

...

Keyword(s):

Palliative Care ◽

Patient Care ◽

Symptom Assessment ◽

Assessment System ◽

Assessment Tools ◽

Direct Patient Care ◽

Optimal Care ◽

Goals Of Care ◽

Care Plans ◽

Palliative Care Setting

Background: Optimal care for patients in the palliative care setting requires effective clinical teamwork. Communication may be challenging for health-care workers from different disciplines. Daily rounds are one way for clinical teams to share information and develop care plans for patients. Objective: The objective of this initiative was to improve the structure and process of daily palliative care rounds by incorporating the use of standardized tools and improved documentation into the meeting. We chose a quality improvement (QI) approach to address this initiative. Our aims were to increase the use of assessment tools when discussing patient care in rounds and to improve the documentation and accessibility of important information in the health record, including goals of care. Methods: This QI initiative used a preintervention and postintervention comparison of the outcome measures of interest. The initiative was tested in a palliative care unit (PCU) over a 22-month period from April 2014 to January 2016. Participants were clinical staff in the PCU. Results: Data collected after the completion of several plan-do-study-act cycles showed increased use and incorporation of the Edmonton Symptom Assessment System and Palliative Performance Scale into patient care discussions as well as improvement in inclusion of goals of care into the patient plan of care. Conclusion: Our findings demonstrate that the effectiveness of daily palliative care rounds can be improved by incorporating the use of standard assessment tools and changes into the meeting structure to better focus and direct patient care discussions.

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Patient care guidelines: A telephone survey of intensive care practices in New South Wales

Australian Critical Care ◽

10.1016/j.aucc.2009.10.001 ◽

2010 ◽

Vol 23 (1) ◽

pp. 21-29 ◽

Cited By ~ 6

Author(s):

Serena Knowles ◽

Kaye Rolls ◽

Doug Elliott ◽

Jennifer Hardy ◽

Sandy Middleton

Keyword(s):

Intensive Care ◽

Patient Care ◽

Telephone Survey ◽

New South ◽

New South Wales ◽

South Wales ◽

Care Guidelines ◽

Care Practices

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APRN Palliative Care Externship: Potential impact on oncology nursing palliative care delivery.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.149 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 149-149

Author(s):

Constance Dahlin ◽

Patrick J. Coyne ◽

Brian Cassel

Keyword(s):

Palliative Care ◽

Patient Care ◽

Care Delivery ◽

Improve Patient Care ◽

Rural Practice ◽

Oncology Nursing ◽

Advanced Practice ◽

Care Providers ◽

Positive Effects ◽

Improve Patient

149 Background: Understanding primary palliative care is essential for advanced practice nurses, no matter where they practice. Limitations resulting from the variability of APRN state practice acts, financial considerations, and expenses, challenge post-graduate education for APRNs. With the shortage of health care providers, it is necessary to consider innovative programs to offer this education. Although there are many palliative educational opportunities, there are few abilities to translate the education into practice. Few are focused on the APRN, particularly for community and rural practice where many oncology patients are located and receive care. Methods: The APRN Externship selected 48 externs who completed the week long course. Topics includes pain and symptom assessment and management; fostering communication skills; building understanding of community resources such as hospice, palliative care, and home care; incorporating palliative care into an oncology practice, introducing concepts of business and finance in palliative care; and developing of safe practice with policy, procedure, and guideline development with a focus on rural providers. Externs complete pre course and post course testing along with completing goals to improve patient care. Results: Through an IRB approved process, utilizing both quantitative and qualitative evaluation, we followed the effect of the externship on externs. Externs performed both pre-course as well as 1 month and 6 month post-course testing. They also completed a report on achievement of clinical goals to improve patient care delivery. Conclusions: APRN Palliative Externs reported positive effects from the externship experience to clinical practice. The qualitative and quantitative data has demonstrated sustained effect towards improving palliative care within advanced practice nursing. The APRN palliative externship model could serve as a model to promote better palliative care education for oncology APRNs thereby improving palliative care delivery within oncology nursing.

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