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LEWISTON, ID

LEWISTON, ID. EXPANDING THE HORIZONS OF CARE PALLIATIVE CARE: STANDARD OF CARE AND SERVICE. SJRMC PALLIATIVE CARE. Becky Witt, RN, Director PC Margie Schmidt, LCPC, Chaplain. SJRMC.

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LEWISTON, ID

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  1. LEWISTON, ID EXPANDING THE HORIZONS OF CARE PALLIATIVE CARE: STANDARD OF CARE AND SERVICE

  2. SJRMC PALLIATIVE CARE • Becky Witt, RN, Director PC • Margie Schmidt, LCPC, Chaplain

  3. SJRMC • Situated near the confluence of the Snake and Clearwater Rivers in Lewiston, ID, SJRMC has been providing medical care to the Lewiston-Clarkston Valley and surrounding 8 counties since 1902 when the Sisters of St. Joseph of Carondelet began giving medical services in a small frame house near the Snake River. From this modest beginning, SJRMC has grown to be a regional medical center.

  4. A not-for-profit hospital sponsored by Ascension Health System • Licensed to operate 125 acute medical/surgical care beds • 20 adult acute care psychiatric beds • 16 skilled nursing facility beds-TCU • Offers Mental Health Center with inpatient and out patient facilities

  5. SJRMC • Radiation/Oncology and Cancer Centers • Family Hospice • Outpatient Rehab services • Only non-critical access hospital in 9 counties • Surrounded by 7 Critical Access Hospitals • Primary service population equals 18.6% persons 65 years or older vs. national and state % of 12.0%

  6. PALLIATIVE CARE • Palliative care is specialized medical care for people with serious illness. This type of care is focused on providing pts. with relief from the symptoms, pain and stress of serious illness-whatever the diagnosis. • The goal is to improve quality of life for both the pt. and the family.

  7. PALLIATIVE CARE • Palliative care is provided by a team of physicians, nurses, and other specialists who work with a pts. other physicians to provide an extra layer of support. • Palliative care is appropriate at any age and at any stage in a serious illness and can be provided together with curative treatment.

  8. PALLIATIVE CARE • SUMMARY: • Relief • Information • Choice and control • Continuity

  9. GOAL OF PALLIATIVE CARE • To achieve optimal quality of life for the patient and their family through a plan of pain and symptom relief, spiritual & psychosocial support with respect for human dignity. • PALLIATIVE CARE: Comes from the Latin palliare, which means to cloak

  10. PALLIATIVE CARE • Patient and family are the focus of care with a team approach. • Work with the physician and nurses to provide wholistic care.

  11. SERVICES INCLUDE • Interdisciplinary assessment of patients • Consultation about symptom management • Bedside consultation with patients/families concerning advanced illness and end of life issues • Assistance in clarifying and communication of treatment and quality of life goals

  12. SERVICES INCLUDE • Therapeutic utilization of the Palliative Care Suite for patients/families with complex symptom management who are in need of a unique family focused environment • Bereavement services follow-up • Outcome monitoring for evaluation of services and program development

  13. BENEFITS OF PALLIATION • Support in making end of life choices • Education to patient/families, staff, physicians & community • Help in making complex decisions, determining goals of care • Pain and symptom control • Psych/social/spiritual support • Bereavement program • Invitation to Memorial Services

  14. Palliative Care History @ SJRMC • Officially started spring 2008 • Began through efforts of two local oncologists, along with members of the leadership team @ SJRMC • Program is for inpatients and focused palliative care is provided throughout the medical center, inpatient and Transitional Care

  15. Palliative Care History @ SJRMC • Goals and purpose of a Palliative Care program are consistent and inherently complimentary with the philosophy, mission and values that have been in place at SJRMC for over 100 years.

  16. PC TEAM MEMBERS • Medical Director-Oncologist • Director-Hospitalists • VP PCS • RN, Director Palliative Services • RN-Med/Onc • RN, Liaison

  17. PC TEAM MEMBERS • Director Pastoral Care • Chaplain • MSW • Pharmacist • Director, ED

  18. Team Meetings • Team meets every Wednesday morning • Begins with quiet and prayer • Discuss pc patients who died the past week • Discuss present palliative care patients • Discuss possible palliative care patients • Discuss how the team can be of help to the Doctors and staff • Make a plan of action and assign follow up

  19. In Patient Palliative Care @ SJRMC • Involvement of ER Director and staff as frontline “gatekeepers” of potential patients • Any room in SJRMC can be a Palliative Care room • Education and support of staff and physicians • Provide additional support for patient and family by the team members

  20. In Patient Palliative Care @ SJRMC • Monitor patient’s physical, psychosocial and spiritual well-being • Provide a cart with coffee, snacks, and fruit • Assist with discharge planning • Nurses are trained to care for palliative patients • Patient Satisfaction survey • Palliative Care room on 3C

  21. Recognizing individuals who could be served by Palliation Services • Patients/Family who require help and support with complex decision making and determination of goals • Patients with late stage chronic illness • Patients with a chronic unacceptable level of pain or other symptoms that create distress for the person

  22. Recognizing individuals who could be served by Palliation Services • Patient/family with uncontrolled psychosocial or spiritual issues • Patients who have frequent visits to the emergency department for the same problems (i.e. more than one time per month over a period of time.) • Patients who have frequent hospital admissions for the same diagnosis with declining functional status

  23. Recognizing individuals who could be served by Palliation Services • Patients who have a prolonged length of stay without evidence of progress • Patients who have a prolonged length of stay in ICU without evidence of progress or documented poor prognosis for whom continued aggressive intervention is overly burdensome • Other persons who the health care team believe might benefit from palliation services

  24. REFERRALS Physicians and other members of the care team may refer inpatients to the palliative care program for evaluation. The team may identify patients who may benefit from evaluation and services and facilitate discussion regarding potential introduction to palliation care. Goal: Earlier referrals from physicians.

  25. STATS • April 23, 2009 to June 30, 2011 • 186 referrals to Palliative Care • 25 referrals from ICU • 80 referrals from Hospitalists • 88 referrals from Oncologists • 18 referrals from other physicians • 13 patients still living

  26. REGENCE SOJOURNS TWO YEAR GRANT • Further develop the Palliative Care-Hospice RN Liaison position to extend into the community • Education to physicians, physician extenders, potential patients/families and the general public • Education to palliative care team members

  27. REGENCE SOJOURNS TWO YEAR GRANT • Sponsorship of a formal education program by an expert in palliation and end of life of care for area physicians and nurses • Initiate strategies to develop a mid-level provider role • Sponsor a physician to complete education requirement to become board certified in palliation and hospice services

  28. Making a Difference • Goal clarification • Symptom Management • Addressing Difficult Physical, Emotional and Spiritual Issues with patients and families

  29. Making a Difference • End of Life Discussions including DNR (AND) status • “Allowing” people to die comfortably and peacefully

  30. Spiritual Care • From it inception, Spiritual Care was a vital component to Palliative Care • When an order for PC is entered into our system, a referral is automatically triggered for Spiritual Care • Every PC patient receives chaplain’s visits • Chaplain assesses level of spiritual support needed and responds to the needs

  31. “Moving Away from the Known” • Divine Journeyer, I am in a strange, unsettling place in my transitory life. I have left much behind me. I have questions about the changes and wonder about the adjustments. It is easy to doubt my decisions and to wonder if I will be all right. Assure me of your nearness. Clothe me in a garment of hope. Teach me to be patient as I find my way in life. • Joyce Rupp, Your Sorrow is My Sorrow

  32. PC: Walking with Others • As they live in an unsettling place • As they leave much behind • As they have questions about changes • As they wonder about adjustments • As they make decisions

  33. PC: Walking with Others • Assuring them they are not alone • Clothing them in a garment of hope • Helping them to find their way in life

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