The contribution of the clinical pharmacist in palliative care

2021 ◽  
pp. 248-254
Author(s):  
Ebtesam Ahmed
Keyword(s):  
Palliative Care ◽  
Positive Impact ◽  
Symptom Control ◽  
Pharmacy Practice ◽  
Care Practice ◽  
Additional Information ◽  
The Us ◽  
Medication Disposal ◽  
Medication Counselling

Pharmacists are exceptionally positioned to deliver expert medication consultation and teaching, thus creating a specialized role within the palliative care team to optimize and rationalize medication use. The role pharmacists play varies among different palliative care practice settings; however, all pharmacists participate in providing pharmaceutical care. Activities of pharmacists can include identifying and resolving adverse drug-related problems, reconciling medication, developing medication guidelines, helping patients and families with medication disposal, and providing medication counselling as well as patient psychological support. Pharmacy organizations support pharmacists as key members of interdisciplinary care, and there is growing recognition of the value of their contribution. This chapter reviews the role of clinical pharmacists and is based mainly on the situation in the US with additional information from other parts of the world. It highlights the positive impact of pharmacy practice through improved symptom control, identifying, preventing, and resolving medication-related problems.

Evaluation of Targeted Pharmacist Interventions to Reduce Length of Stay in an Acute Care Practice Model

2018 ◽  
Vol 53 (5) ◽  
pp. 471-477 ◽  
Author(s):  
Mary-Haston Leary ◽  
Kathryn Morbitzer ◽  
Bobbi Jo Walston ◽  
Stephen Clark ◽  
Jenna Kaplan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Positive Impact ◽  
Pharmacy Practice ◽  
Care Practice ◽  
Readmission Rates ◽  
A Value ◽  
Pharmacist Interventions ◽  
Semistructured Interviews ◽  
The Impact

Background: Despite widespread recognition of the need for innovative pharmacy practice approaches, the development and implementation of value-based outcomes remains difficult to achieve. Furthermore, gaps in the literature persist because the majority of available literature is retrospective in nature and describes only the clinical impact of pharmacists’ interventions. Objective: Length of stay (LOS) is a clinical outcome metric used to represent efficiency in health care. The objective of this study was to evaluate the impact of pharmacist-driven interventions on LOS in the acute care setting. Methods: A separate samples pretest-posttest design was utilized to compare the effect of pharmacist interventions across 3 practice areas (medicine, hematology/oncology, and pediatrics). Two time periods were evaluated: preimplementation (PRE) and a pilot period, postimplementation of interventions (POST). Interventions included targeted discharge services, such as discharge prescription writing (with provider cosignature). Participating pharmacists completed semistructured interviews following the pilot. Results: A total of 924 patients (466 PRE and 458 POST) were included in the analysis. The median LOS decreased from 4.95 (interquartile range = 3.24-8.5) to 4.12 (2.21-7.96) days from the PRE versus POST groups, respectively ( P < 0.011). There was no difference in readmission rates between groups (21% vs 19.1%, P = 0.7). Interviews revealed several themes, including positive impact on professional development. Conclusion and Relevance: This pilot study demonstrated the ability of pharmacist interventions to reduce LOS. Pharmacists identified time as the primary barrier and acknowledged the importance of leaders prioritizing pharmacists’ responsibilities. This study is novel in targeting LOS, providing a value-based outcome for clinical pharmacy services.

scholarly journals Role of the clinical nurse specialist as a non-medical prescriber in managing the palliative care needs of individuals with advanced lung cancer

2021 ◽  
Vol 27 (4) ◽  
pp. 205-212
Author(s):  
Jenny Osborne ◽  
Helen Kerr
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Positive Impact ◽  
Clinical Nurse Specialist ◽  
Advanced Lung Cancer ◽  
Nurse Specialist ◽  
Care Needs ◽  
Clinical Nurse ◽  
Palliative Care Needs

Background: Rapid identification of the palliative care needs of individuals with a diagnosis of advanced lung cancer is crucial to maximise the patient's quality of life by upholding exemplary standards of patient-centred holistic care. The clinical nurse specialist is in an ideal position to contribute to the identification and management of the palliative care needs of individuals with advanced lung cancer through the assessment and timely prescribing of medications to manage distressing symptoms. Aim: This paper reviews and critiques the role of the clinical nurse specialist as an independent non-medical prescriber in the management of palliative symptoms in end-of-life care for patients with advanced lung cancer. Results: Published literature highlights the positive impact the clinical nurse specialist has as a non-medical prescriber in addressing the palliative needs of individuals with lung cancer. However, there are barriers and challenges, and to overcome these, maximising resources and the availability of support is required to ensure the delivery of timely, person-centred care. Conclusion: The clinical nurse specialist as a non-medical prescriber is an evolving role. There are a range of factors that may influence the clinical nurse specialist to confidently and competently undertake this role. These include the perception that there will be an escalation in the workload, concerns about increased accountability and inadequate mentoring for this new role. To incentivise this role, multidisciplinary support is essential in promoting the clinical nurse specialist's confidence for developing this service to individuals with advanced lung cancer.

scholarly journals Palliative care at home: Carers and medication management

2008 ◽  
Vol 6 (4) ◽  
pp. 349-356 ◽  
Author(s):  
Barbara A. Anderson ◽  
Debbie Kralik
Keyword(s):  
Palliative Care ◽  
Medication Management ◽  
Symptom Relief ◽  
Symptom Control ◽  
Subcutaneous Administration ◽  
Care Practice ◽  
Home Based ◽  
Palliative Care Setting ◽  
Care At Home ◽  
At Home

ABSTRACTObjective:The decision to receive palliative care at home brings with it the complexity of managing a medication regime. Effective symptom control is often directly linked to medication management and relies on access to medications at all times. In home-based palliative care practice, polypropylene syringes of medications may be drawn up and left in clients' domestic refrigerators for subcutaneous administration by carers to provide immediate relief for symptoms such as pain and nausea. However, although there has been some discussion in the literature about the need for ready access to medications for symptom control of clients receiving care in the community, the feasibility of this practice has received scant attention. The aim of this article is to present the carers' experiences of administering medications in this manner.Methods:Semistructured interviews with 14 carers, who were administering medication in a home-based palliative care setting, were analyzed using qualitative methods to develop meaning units and themes.Results:Interviews revealed that this practice was highly valued. The carers willingly assumed the responsibility of medication administration, as it allowed the clients to remain at home where they desired to be. They could provide immediate symptom relief, which was of utmost importance to both the client and carer. The carers were empowered in their caring role, being able to participate in the care provided, rather than standing on the sidelines as helpless observers. Carers acknowledged the security and ethical issues associated with the presence of certain medications in the home and valued the 24-h telephone support that was available to them. After clients had died, the carers reflected on their involvement in care and felt a sense of pride and achievement from administering medications in this way because they had been able to care for their loved ones at home and fulfill their wish to die there.Significance of results:These interviews confirm the feasibility of this practice, which is a component of quality end-of-life care.

Safe and effective prescribing for symptom management in palliative care

2019 ◽  
Vol 80 (12) ◽  
pp. C184-C189
Author(s):  
Dylan Harris
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Symptomatic Relief ◽  
Symptom Control ◽  
Upper Airway ◽  
Life Care ◽  
Proactive Approach ◽  
Key Points

Palliative and end of life care forms an important part of the role of any doctor in training, and an awareness of a structured approach to managing common symptoms and end of life care is essential. Common symptoms include pain, nausea and vomiting, constipation, and breathlessness. Anticipatory prescribing of the 4 A's (analgesic, anti-emetic, anxiolytic, and anti-secretory) is a proactive approach to ensure medication is available, if required, for common symptoms in the last hours to days of life, such as pain, upper airway secretions, anxiety, and agitation. Prescribing or medication errors in relation to symptom control in palliative care can relate to individual errors, poor communication, poor care coordination, equipment and care planning. There are some important key points relating to prescribing to consider, for example, using recognized conversions when changing between opioids and from the oral to syringe drivers route; that diamorphine and morphine are not equipotent; prescribing liquid opioids in milligrams not millilitres where there are multiple concentrations available; making the indication for steroids clear when used, as they are multiple possible indications (and also their intended duration, to avoid unintended longer term sequelae of steroid use); and avoiding the use of oxygen for symptomatic relief of breathlessness in the absence of hypoxia.

scholarly journals COVID-19, Suffering and Palliative Care: A Review

2021 ◽  
pp. 104990912110462
Author(s):  
Tan Seng Beng ◽  
Carol Lai Cheng Kim ◽  
Chai Chee Shee ◽  
Diana Ng Leh Ching ◽  
Tan Jiunn Liang ◽  
...  
Keyword(s):  
Palliative Care ◽  
Healthcare Workers ◽  
Psychosocial Support ◽  
Symptom Control ◽  
Physical Symptoms ◽  
Integral Component ◽  
Who Guideline

According to the WHO guideline, palliative care is an integral component of COVID-19 management. The relief of physical symptoms and the provision of psychosocial support should be practiced by all healthcare workers caring for COVID-19 patients. In this review, we aim to provide a simple outline on COVID-19, suffering in COVID-19, and the role of palliative care in COVID-19. We also introduce 3 principles of palliative care that can serve as a guide for all healthcare workers caring for COVID-19 patients, which are (1) good symptom control, (2) open and sensitive communication, and (3) caring for the whole team. The pandemic has brought immense suffering, fear and death to people everywhere. The knowledge, skills and experiences from palliative care could be used to relieve the suffering of COVID-19 patients.

Impact of Medical Assistance in Dying on palliative care: A qualitative study

2020 ◽  
pp. 026921632096851
Author(s):  
Jean Jacob Mathews ◽  
David Hausner ◽  
Jonathan Avery ◽  
Breffni Hannon ◽  
Camilla Zimmermann ◽  
...  
Keyword(s):  
Palliative Care ◽  
Ethical Decision Making ◽  
Care Delivery ◽  
Symptom Control ◽  
Care Practice ◽  
Care Providers ◽  
Medical Assistance ◽  
Assisted Death ◽  
Medical Assistance In Dying ◽  
The Impact

Background: Medical Assistance in Dying comprises interventions that can be provided by medical practitioners to cause death of a person at their request if they meet predefined criteria. In June 2016, Medical Assistance in Dying became legal in Canada, sparking intense debate in the palliative care community. Aim: This study aims to explore the experience of frontline palliative care providers about the impact of Medical Assistance in Dying on palliative care practice. Design: Qualitative descriptive design using semi-structured interviews and thematic analysis Settings/participants: We interviewed palliative care physicians and nurses who practiced in settings where patients could access Medical Assistance in Dying for at least 6 months before and after its legalization. Purposeful sampling was used to recruit participants with diverse personal views and experiences with assisted death. Conceptual saturation was achieved after interviewing 23 palliative care providers (13 physicians and 10 nurses) in Southern Ontario. Results: Themes identified included a new dying experience with assisted death; challenges with symptom control; challenges with communication; impact on palliative care providers personally and on their relationships with patients; and consumption of palliative care resources to support assisted death. Conclusion: Medical Assistance in Dying has had a profound impact on palliative care providers and their practice. Communication training with access to resources for ethical decision-making and a review of legislation may help address new challenges. Further research is needed to understand palliative care provider distress around Medical Assistance in Dying, and additional resources are necessary to support palliative care delivery.

scholarly journals E-learning: who uses it and what difference does it make?

2019 ◽  
Vol 25 (10) ◽  
pp. 482-493 ◽  
Author(s):  
Deb Rawlings ◽  
Jennifer Tieman ◽  
Carly Moores
Keyword(s):  
Palliative Care ◽  
Health Professionals ◽  
Healthcare Professionals ◽  
Clinical Care ◽  
Care Practice ◽  
Learning Modules ◽  
Relevant Evidence ◽  
E Learning ◽  
Meaningful Data

Background: CaseSearch ‘My Learning’ e-learning modules were designed to remind clinicians and practitioners about the role of evidence in practice and demonstrate how to find relevant evidence to make a difference in clinical care. This study aims to describe the role of the modules and their uptake, and determine whether the modules influenced the learners' palliative care practice and whether the modules were easy to use. Method: Two sets of questions were designed to capture data to evaluate the modules. Findings: The modules supported the awareness and use of evidence by health professionals. The modules contribute to ongoing professional development for practitioners and can improve palliative care practice. Conclusion: It is possible to collect meaningful data that contributes to understanding who uses e-learning resources and how useful healthcare professionals find them.

Role of Symptom Control and Palliative Care Abstract Presentations

2002 ◽  
Vol 20 (3) ◽  
pp. 880-882
Author(s):  
Jamie H. Von Roenn ◽  
David Scheinberg ◽  
Patrick J. Loehrer ◽  
Catherine Sweeney ◽  
Leaha Beattie-Palmer ◽  
...  
Keyword(s):  
Palliative Care ◽  
Symptom Control
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