palliative care orientation presentation at 27 may 2010 (1)

8/3/2019 Palliative Care Orientation Presentation at 27 MAy 2010 (1)

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Palliative Care InPalliative Care In

The Acute SettingThe Acute Setting


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AimsAims To provide participants with a definition ofTo provide participants with a definition of

palliative carepalliative care

Define the key palliative care serviceDefine the key palliative care serviceproviders across all settingsproviders across all settings

To understand the importance of applying aTo understand the importance of applying apalliative care approach to your carepalliative care approach to your care

Highlight further supportHighlight further support


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PalliativePalliative CareCare isis anan approachapproach thatthat improvesimprovesthethe qualityquality ofof lifelife ofof patientspatients andand theirtheir

familiesfamilies facingfacing thethe problemsproblems associatedassociated withwithlifelife--threateningthreatening illness,illness, throughthrough thethepreventionprevention andand reliefrelief ofof sufferingsuffering byby meansmeans

ofof earlyearly identificationidentification andand impeccableimpeccableassessmentassessment andand treatmenttreatment ofof painpain andand otherotherproblems,problems, physicalphysical,, psychologicalpsychological andandspiritualspiritual.. (WHO(WHO 20032003))

What is Palliative care


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The Philosophy of NursingThe Philosophy of Nursing Patient centredPatient centred

approachapproach

PartnershipPartnership

Holistic approachHolistic approach

RespectRespect

Promotion ofPromotion ofcomfort and dignitycomfort and dignity


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The Philosophy of PalliativeThe Philosophy of Palliative

CareCare

Patient centred approachPatient centred approach

PartnershipPartnership Holistic approachHolistic approach

RespectRespect

Promotion of comfort and dignityPromotion of comfort and dignity


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Essential Components ofEssential Components of

Palliative CarePalliative Care Effective communicationEffective communication

Symptom controlSymptom control

RehabilitationRehabilitation

Education and trainingEducation and training

Research and auditResearch and audit

Continuity of careContinuity of care Terminal careTerminal care

Bereavement supportBereavement support


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chaplain

Hospices

Pysio/SALTS/

OT/Dietician

Pharmacist

Hospital

Team

Social workDentist

Marie Curie

(overnight

care)

District Nurse

GP

Palliative

Clinical Nurse

Specialist

Family / Carers

Palliative Care in Hospitals is supportedPalliative Care in Hospitals is supportedby alarge multiby alarge multi--disciplinary Teamdisciplinary Team

Palliative Care Practice

Development Team


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ToTo support patientssupport patients with palliative carewith palliative careneedsneeds

ToTo support carerssupport carers of patients withof patients withpalliative care needspalliative care needs

ToTo supportall staffsupportall staff to deliver qualityto deliver qualitypalliative care to patientspalliative care to patients

ToTo review patients and support staffreview patients and support staffwith complex physical and emotionalwith complex physical and emotionalsituationsituation

ToTo provideprovide educationeducation to patients, carersto patients, carersand colleaguesand colleagues

To advance the practice of palliative careTo advance the practice of palliative carewithwith research and auditresearch and audit

The Role of Hospital

Palliative Care Teams


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Where are we nowWhere are we now 6 Hospices within GG&C6 Hospices within GG&C

Palliative care teams introduced into thePalliative care teams introduced into the

Acute Care Setting early 2000Acute Care Setting early 2000 Links with Hospices and Care HomesLinks with Hospices and Care Homes

commissioned postscommissioned posts

Challenges for equitable access toChallenges for equitable access toservices for all no matter age, culture,services for all no matter age, culture,and diagnosisand diagnosis


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Epidemiology, ScotlandEpidemiology, Scotland

27,400 new cancers in 200727,400 new cancers in 2007

100,000 living with heart failure (2008)100,000 living with heart failure (2008)

10,500 MS (2009) 1:500 one of highest per capita in10,500 MS (2009) 1:500 one of highest per capita in

the worldthe world Approx 120, 000 living with Parkinsons DiseaseApprox 120, 000 living with Parkinsons Disease

(2010)(2010)

350 MND (2008/09) increase from 280350 MND (2008/09) increase from 280

90,000 live with COPD (one of the highest rates in90,000 live with COPD (one of the highest rates inEurope)2009Europe)2009

58,00058,000 -- 65,000 dementia predicted to rise to65,000 dementia predicted to rise to100,000 by 2031(Living and Dying Well. 2008)100,000 by 2031(Living and Dying Well. 2008)


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Numbers and Place of DeathNumbers and Place of DeathNHS Scotland v Greater Glasgow and ClydeNHS Scotland v Greater Glasgow and Clyde

TotalTotal 55,70055,700 TotalTotal 13,68813,688

TOTAL -13,688

57%20%

23%

Hospital

Other Inst

Non Inst58%

19%

23%

Hospital

Other Inst

Non Inst


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Causes of death GGC 2008Causes of death GGC 2008 --Top 5Top 5No. ofNo. ofdeathsdeaths HospitalHospital OtherOtherinstitutioinstitutio

nn

NonNoninstitutioinstitutionn

All deathsAll deaths 13,68813,688 57%57% 20%20% 23%23%

Ischemic HeartIschemic HeartDiseaseDisease

2,0722,072 47%47% 10%10% 43%43%

CerebrovascularCerebrovascularDiseaseDisease

12741274 64%64% 25%25% 11%11%

Ca bronch, lung,Ca bronch, lung,tracheatrachea

11701170 48%48% 27%27% 25%25%

Chronic LowerChronic Lowerrespiratoryrespiratory

775775 71%71% 10%10% 19%19%

Dementia &Dementia &AlzheimersAlzheimers

723723 35%35% 61%61% 4%4%


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No. ofNo. ofdeathsdeaths

HospitalHospital OtherOtherinstitutioinstitutio

nn

NonNoninstitutioinstitutio

nn

All deathsAll deaths 1368813688 57%57% 20%20% 23%23%

Influenza andInfluenza andpneumoniapneumonia

675675 71%71% 21%21% 8%8%

Cirrhosis and otherCirrhosis and otherliverliver

445445 72%72% 2%2% 26%26%

Ca colon etcCa colon etc 384384 39%39% 33%33% 28%28%

Urinary diseaseUrinary disease 310310 78%78% 17%17% 5%5%

Ca breastCa breast 247247 40%40% 38%38% 22%22%

Causes of death GGC 2008 - 6-10


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Policy context - Scotland


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Tools/triggers to identifyTools/triggers to identifyneedsneeds

Assessment toolsAssessment tools

Palliative care for allPalliative care for allincluding elderly and LTCincluding elderly and LTC

Primary care registersPrimary care registers

Just in case boxesJust in case boxes

Service info directoriesService info directories Lothian DNACPR policyLothian DNACPR policy

24 hour community24 hour communitynursingnursing

Access to equipmentAccess to equipment Processes to enable safeProcesses to enable safe

transfertransfer

Education championEducation champion

Work with voluntaryWork with voluntarysectorsector

The plan


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The Current PrioritiesThe Current Priorities GSF to encompass all patients withGSF to encompass all patients with

palliative care diagnosispalliative care diagnosis

Liverpool Care Pathway (LCP)Liverpool Care Pathway (LCP)

DNACPRDNACPR

Advance Care PlanningAdvance Care Planning

Adoption of Lothian SMGAdoption of Lothian SMG


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Balancing PrioritiesBalancing Priorities Essential careEssential care

Palliative CarePalliative Care

DocumentationDocumentation

Workforce planning/developmentWorkforce planning/development


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Palliative and end of life care will always bePalliative and end of life care will always bepart of our role in hospitals so we have to bepart of our role in hospitals so we have to be

able to deliver effectivelyable to deliver effectively We have to be able to assess and listen toWe have to be able to assess and listen to

patients and families who are living with lifepatients and families who are living with lifelimiting illness from the time of the diagnosislimiting illness from the time of the diagnosis

We must be able to deliver care which isWe must be able to deliver care which isholisticholistic and meets the needs identified byand meets the needs identified bypatients and familiespatients and families


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Further Help and SupportFurther Help and Support Palliative Care ModulesPalliative Care Modules

Liverpool Care Pathway Champions SupportLiverpool Care Pathway Champions SupportProgrammeProgramme

Use of subcutaneous medication in palliative careUse of subcutaneous medication in palliative care

Mckinley Pump TrainingMckinley Pump Training

Palliative Care resource foldersPalliative Care resource folders

Respond to any enquires regarding practiceRespond to any enquires regarding practice

ACPACP

DNACPRDNACPR

LSMGLSMG


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Final Thoughts!Final Thoughts!

You matter because you are you,You matter because you are you,and you matter untilthe lastand you matter untilthe lastmoment of yourlife. We will do allmoment of yourlife. We will do allwe can not only to help you diewe can not only to help you die

peacefully butalso to live until youpeacefully butalso to live until youdiedie

palliative care orientation presentation at 27 may 2010 (1)

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