Defining a Palliative Care Consult:Core Elements

Defining a Palliative Care Consult:Core Elements

Cheryl Phillips, M.D.

SH Palliative Care Committee

April 30, 2007

BackgroundBackground

Need to move to some definitional standards for measurement, reporting and delivery

Variation anticipated with the local teams and facility resources

Despite team variation, there should be some common elements that occur in order to “counted” as a Palliative Care consult within the Sutter system.

This is critical for the physicians to understand and utilize palliative care programs and is critical for patients and their families to have consistency of service and care across our system

In-Patient Hospital Palliative Care Consult:Key Elements for Documentation

In-Patient Hospital Palliative Care Consult:Key Elements for Documentation

Evaluation and discussion of patient’s goals of care – may refer to existing documentation if already done

Determination of decision-maker (patient or assigned surrogate). If none, then such should be noted in record

Review of current treatment plan Review of advance directives and discussion with

patient/surrogate as needed. May also refer to existing documentation that may be present in the medical record

Assessment of pain and non-pain symptoms Recommendations for interventions to address symptom

management Referral, as needed to spiritual support and social services Documentation of above in the medical record to be used

by the health care team

Example Case DocumentationExample Case Documentation

Pt. is a 66 yr old with advanced COPD. She is her own decision-maker, but her husband is very involved in care. She has made clear expressions of her wish to not be intubated or have CPR and this is recorded in her record.

PC consult was requested to address patient’s anxiety and SOB and also to provide support to her husband.

Case continued: AssessmentCase continued: Assessment

On assessment she is clearly anxious and breathing rapidly. She denies pain but complains of feeling “claustrophobic and panicy”

Lengthy discussion was had about her and her husband’s understanding of her disease and what her goals are. In the past she had believe “this would get better” but now understands that she is end-stage (per her pulmonologist). She has been intubated twice in past. Her goals are now Comfort Care. She wants to go home, she wants to be comfortable and she does not wish any further intubation

Case Continued: PlanCase Continued: Plan

The following recommendations were made to improving her SOB and anxiety: (listed)

Hospice was discussed and offered. Patient agrees and wishes to be DC’d home with hospice.

I have discussed this with her attending physician who is in agreement and wishes for a formal Hospice referral.