SOMC Hospice - Scioto County Medical Society
Download
Report
Transcript SOMC Hospice - Scioto County Medical Society
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)
Diagnosis
categories
appropriate for
Hospice Care:
Cancer
Alzheimer’s
Stroke & Coma
Cardiac
Renal
Hepatic
Dementia
ALS
Failure to Thrive
Debility
HIV
General
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 followedup within one hour
The Hospice Team
Skilled Nursing –
Provided under the direction of the
physician
Weekly visits and as needed
Provide comprehensive assessment
with each visit
Provide emotional support
Focus on patient/caregiver education
Nurses available 24 hours a day,
seven days a week
Coordinate 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 hygiene
Assist family members in learning
care-giving skills
Visit 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 resources
Provide social and psychosocial
counseling
Assistance with advance directives
Participate in the IDT Plan of Care
The Hospice Team (cont)
Spiritual Care –
Presence ministry
Life review
Sacramental needs
Contacting patient’s church/personal
clergy
End of life spirituality
Special 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 meetings
Covers patient admissions to the
Hospice Center as needed
Contributes 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 Justification
Intent: Relief of suffering, as a last
resort
Outcome: 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 irreversible
Indicated only for refractory symptoms
– when nothing else is working
Appropriate when patient is imminent
or getting close to death
Palliative Sedation:
Reasons for sedation –
Pain
Terminal restlessness/delirium
Dyspnea
Bleeding
Nausea/vomiting
**Symptoms must be truly refractory
Palliative Sedation:
Drug Classifications –
Opioids
Benzodiazepines
Antipsychotics
Barbiturates
General 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)
DNRCC
All other treatments must have been
exhausted
Psychosocial assessment
Spiritual assessment
Palliative Sedation:
Suggested Guidelines Second physician opinion
Nutrition/hydration futility addressed
Reason(s) well documented
Consideration of a trial of respite
sedation first
Use of a proper sedation scale
Hospice Service Areas
Scioto County
Pike County
Jackson County
Counties partly covered:
Lawrence
Adams
Ross
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 Patient
Acute stay – pain and/or symptoms
unable to ideally be treated in home
setting
Imminent 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 lifelimiting 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???