Palliative Care End of Life and the sky is the limit from thereSlide 2
Palliative consideration expects to soothe enduring and enhance the nature of living and kicking the bucket. Palliative is from the Greek word "to shroud"Slide 3
Palliative Care: Some Definitions The study and administration of patients with dynamic, dynamic, far-cutting edge sickness for whom guess is constrained and the center of consideration is personal satisfaction (QOL) (British Board of Medical Specialties, 1987)Slide 4
Active, all out consideration of patients whose malady is not receptive to healing treatment. Control of torment, different manifestations, mental, social otherworldly issues is fundamental. The objective is the accomplishment of the most ideal QOL for patients and their families.Slide 5
Many parts of palliative consideration are likewise relevant prior throughout ailment, in conjunction with hostile to (growth) treatment. (WHO, 1990) Seeks to forestall, diminish, lessen or alleviate the manifestations of the malady or confusion without affecting a cure (IOM, 1997)Slide 6
Myths and Misconceptions Palliative consideration is end-of-life care just Palliative consideration is doing nothing Palliative consideration begins when remedial treatment stops Palliative consideration is new-age "kumbayah"Slide 7
Myths and Misconceptions Palliative consideration implies that restorative consideration has fizzled Palliative consideration is a pleasant however redundant expansion to human services Palliative consideration must be executed by doctors and medical attendants with strength credentialsSlide 8
Palliative Care is fitting for any patient and/or family living with, or at danger of building up an existence debilitating disease because of any finding with any guess paying little heed to age whenever they have unmet desires and/or needs, and are set up to acknowledge care Center to Advance Palliative Care 2000Slide 9
Palliative consideration intends to address: physical, mental, social, profound and useful desires and needs Suffering misfortune, distress and deprivation readiness for, and administration of, self-decided life conclusion, the withering procedure, and passing Center to Advance Palliative Care 2000Slide 10
Palliative consideration is most viably conveyed by an interdisciplinary group. Palliative consideration may supplement and improve infection adjusting treatment, or it might turn into the aggregate center of consideration. Palliative consideration may likewise be appropriate to patients and families encountering intense disease and/or incessant ailment.Slide 11
Distinction: Palliative Care and Hospice Palliative consideration addresses the physical, psychosocial, and profound necessities and desires of patients with intense or constant disease whenever amid that ailment—regardless of the fact that futures reach out to years. Hospice consideration is a palliative consideration "package"provided to patients who have a future of under 6 months if the infection runs its standard course, in the judgment of the patient\'s going to doctor and the hospice restorative executive. Therapeutic mediation is restricted.Slide 12
How Americans Died in the Past . . Mid 1900s normal future 50 years youth mortality high grown-ups lived into their 60sSlide 13
Death in America Today Modern human services just a couple cures live any longer with incessant ailment passing on procedure additionally drawn outSlide 14
Sudden demise, startling cause < 10%, MI, mishap, and so forthSlide 15
Protracted Life-Threatening Illness > 90% unsurprising enduring decay with a generally short "terminal" stage growth moderate decrease punctuated by occasional emergencies CHF, emphysema, Alzheimer\'s-sort dementiaSlide 16
Steady Decline, Short Terminal Phase malignancySlide 17
Slow Decline, Periodic Crises, Sudden Death CHF, emphysema, Alzheimer\'s-sort dementiaSlide 18
The Cure - Care Model: The old framework D E A T H Life Prolonging Care Palliative/Hospice Care Disease ProgressionSlide 19
Palliative Care\'s Place in the Course of Illness Life Prolonging Therapy Death Diagnosis of genuine ailment Palliative Care Medicare Hospice BenefitSlide 20
Common Issues Need for patient and family-focused consideration and congruity Need for clear Treatment Options & Prognosis data Need to address sorrow and misfortune connected with crumbling, choices and demise Need for acknowledgment and rx of dejection Need for group assets, bolster Need for enhanced examination on vindicationSlide 22
Last Acts Report Card, Texas Specific Data < 25% of Texans kick the bucket at home (85-90% state inclination to bite the dust at home) (D) Pain laws meddle with torment alleviation (D) Hospital-based administrations ("E") 31 % of healing centers have torment administration 11% have hospice administrations 9% have palliative administrations 28% of patients >65 who kicked the bucket got hospice care (C) Avg hospice LOS is 25 days (ideal LOS= 60 days) (D)Slide 23
Death in the doctor\'s facility: What do we think about it? Physical enduring Poor to non-existent correspondence about the objectives of restorative consideration Lack of concordance of consideration with patient and family inclinations Huge money related, physical, and enthusiastic weights on family parental figures Suffering in expert guardians Fiscal effect on clinicsSlide 24
National information on the experience of biting the dust in 5 tertiary consideration showing doctor\'s facilities The SUPPORT Study Controlled trial to enhance consideration of truly sick patients Multi-focus study financed by RWJ 9000 patients with life debilitating disease, half kicked the bucket inside 6 months of sectionSlide 25
SUPPORT: Phase I Results 46% of DNR requests were composed inside 2 days of death. Of patients leaning toward DNR, <50% of their MDs knew about their desires. 38% of the individuals who passed on burned through >10 days in ICU. Half of patients had moderate-serious agony >50% of most recent 3 days of life.Slide 26
Pain information from SUPPORT % of 5176 patients reporting moderate to serious torment between days 8-12 of hospitalization: colon cancer 60% liver failure 60% lung cancer 57% MOSF + cancer 53% MOSF + sepsis 52% COPD 44% CHF 43% Desbiens & Wu. JAGS 2000;48:S183-186.Slide 27
CPR Data 133/209 patients who kicked the bucket in CCU more than year and a half got CPR 133 patients experienced 172 scenes of CPR One scene was > 2 hours; 5 were > 60 minutes; national proposals are 10-20 minutes 16 patients survived; no patient who experienced CPR > 1 time survivedSlide 28
Frequency and length of CPR Implement scoring frameworks to help us to perceive patients who won\'t profit by CPR Implement specialized devices and tutoring to help with these troublesome interchanges Educate about development mandates laws and expert duty and obligationSlide 29
Tiffany Suffering (agony, enthusiastic, profound, other) No one knew who she was, what No one recognized what she needed (no objectives of consideration, development order) Communication issues Futile medicines CPR Dignity issuesSlide 30
MISSION The mission of The Methodist Hospital " s Pain and Palliative Care at Program and Supportive Care Consultation Service is to upgrade the personal satisfaction for patients and their families by the anticipation and alleviation of affliction, through thoughtfulness regarding physical, passionate, social, and otherworldly concerns connected with sickness or harm.Slide 31
Goals of Palliative Care at TMH Fully coordinate confirm based manifestation administration and palliative consideration into the consideration conveyance framework, and fuse into the arrangement of tend to each patient. 2. Ensure ideal solace to each patient through the help of forceful agony and indication administration. 3. Ensure that the patient and family objectives of consideration, wishes, and propelled orders are inspired, fused into the arrangement of consideration, and did.Slide 32
Facilitate projects and frameworks that address the otherworldly, enthusiastic, and psychosocial solace of patients and families Assist individuals from the restorative, nursing, and bolster staff to in getting to be learned about palliative consideration/side effect administration, and equipped in related abilities. Contribute quantifiably to expanded patient, family, and staff fulfillment. 7. Contribute quantifiably to decreases in the expense of consideration, length of stay, and death rate.Slide 33
Palliative Care at The Methodist Hospital Education Staff and Physician Education Patient and Family Education Community EducationSlide 34
Clinical Consultation Service Spiritual and Bereavement Care Clinical Care Coordination Research and Outcome Measures Funding and DevelopmentSlide 35
Edmonton Symptom Assessment Scale (ESAS Numerical Scale) Please circle the number that best depicts: No Pain 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Pain Not Tired 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Tiredness Not Nauseated 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Nausea Not Depressed 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Depression Not Anxious 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Anxiety Not Drowsy 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Drowsiness Best Appetite 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Appetite Best Feeling of Well being 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Feeling No Shortness of Breath 0 1 2 3 4 5 6 7 8 9 10 Worst Possible Shortness of Breath Other Problem 0 1 2 3 4 5 6 7 8 9 10Slide 36
A Palliative Care Story Patient Mrs. K 50 years of age 126 days in the doctor\'s facility CA and various medicinal issues Severe neuropathic torment from herpetic injuries in crotch High-measurements opioids creating issues, however no alleviation Liver issues/jaundice from TPN Feculent spewing, hasn\'t eaten in weeks Physicians said "there\'s nothing more we can do"Slide 37
Palliative Care Consultation for Mrs. K Spending as much time as important to discover who she is and what she needs Rigorous manifestation and agony appraisal "Moving mountains" to get IV methadone Symptom (sickness/retching) administration Withdrawing pointless/undesirable treatmentSlide 38
Results of Palliative Care Consultation/Interventions Pain alleviation Relief from queasiness/regurgitating From NPO to clear fluids to
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Conceded from a SNF with a CHF exacerbation3 hospitalizations in 2 months: