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HOSPICEHOSPICE TEL HASHOMERTEL HASHOMER
HOSPICEHOSPICE TEL HASHOMERTEL HASHOMER
TEL AVIV UNIVERSITYSACKLER SCHOOL OF MEDICINE
SCHOOL OF CONTINUING MEDICAL EDUCATION
- אוניברסיטת תל אביבהב”ס לרפואה ע”ש סאקלר
בית הספר ללימודי המשך ברפואה
ASSOCIATED WITH ISRAEL CANCER ASSOCIATION בסיוע האגודה למלחמה בסרטן בישראל
ISRAELISRAEL
Dr. M. Bercovitch
Dr. M. Bercovitch
Dr. M. Bercovitch
Dr. M. Bercovitch
STRUCTURE
Dr. M. Bercovitch
MEDICAL DIRECTOR
PHYSICIAN
PSYCHOLOGIST – 1 -½ part time
SOCIAL WORKER- 1 – ¼ part time
PHYSIOTHERAPIST- 1 – ½ part time
SECRETARY - 1
VOLUNTEERS - 25
*Night shifts- physicians from geriatric department
HEAD NURSENURSES – 15 – part timeNURSING AIDES –5 – part time
25 patients –30Km – surrounding the hospital
PHYSICIAN ½ part time
HEAD NURSE - 1
NURSES –3 –1/2 part time
SOCIAL WORKER – ½ part time
SECRETARY ½ part time
VOLUNTEERS
WORKING AS CONSULTANTS
ON CALL: 24 hours/dayweekends and holidays
HOME CARE HOSPICE
Dr. M. Bercovitch
OTHER ACTIVITIES
Dr. M. Bercovitch
RESEARCH & TEACHING
Medical Research & Information Center
Physician4 volunteers
Nursing Teaching Center
THE CIRCLE OF LIFE
““HOPE ALONGSIDE HOPE ALONGSIDE DEATHDEATH””
Dr. M. Bercovitch
IN THE HOSPICE
37 YEAR OLD MAN BORN IN YEMEN
EMIGRATED TO ISRAEL 1962
MILITARY SERVICE
PROFESSION - AGRICULTOR
NO HISTORY OF SIGNIFICANT
MEDICAL PROBLEMS
MR. E.M
1997 - RECCURENCE OF THE DISEASE IN THE LT THIGH
EXCISION OF THE TUMORCHEMOTHERAPY
CHEMOTHERAPYEXCISION OF THE TUMOR
CHEMOTHERAPY
SUPERIOR VENA CAVA SYNDROME DUE
TO HICKMAN CATHETER THROMBOSIS
1998 - RECCURENCE OF THE DISEASE IN PELVIS INOPERABLE
PRESENT MEDICAL HISTORY
1995 - DG.- LT POPLITEAL MIXOID LIPOSARCOMA
METASTASES TO: LUNG, BONES, LIVERCHEMOTHERAPY
ENCEPHALOPATHY DUE TO CHEMOTHERAPY
1999 - July - LT LOWER ABDOMINAL MASSCHEMOTHERAPY
- September - CLINICAL DISEASE PROGRESSIONSACRAL ROOT COMPRESSION
CAUDA EQUINA SYNDROME
- October - RADIOTHERAPY DISCHARGED HOME
MCR UNO 1000mg X 1/Day TREATED WITH:
12.10.99 - 29.11.99 - AT HOME
POOR GENERAL CONDITIONSEVERE PAIN IN SPINE AND BOTH LOWER LIMBS
GENERAL WEAKNESS
NECROTIC LT LEGBEGINNING NECROSIS OF THE LT FOOT
ABLE TO MOVE IN WHEELCHAIR
TREATED WITH :MCR UNO 1800mg X1/Day
SUMMARY UNTIL ADMISSION
TO OUR HOSPICE
RELATIVELY YOUNG PATIENT WITH
METASTATIC POPLITEAL MIXOID LIPOSARCOMA
TREATED FOR 5 YEARS BY SURGERY,
CHEMOTHERAPY WITH RAPIDLY INCREASING
INTENSITY OF PAIN IN HIS GANGRENOTIC
VERY HIGH DOSES OF MORPHINEWITHOUT PAIN RELIEF
LT LOWER LIMB AND TREATED WITH
DIAGNOSES
INTRACTABLE PAININTRACTABLE PAINPOPLITEAL MIXOID LIPOSARCOMAPOPLITEAL MIXOID LIPOSARCOMA
METASTASES TO THIGH - LEFTMETASTASES TO THIGH - LEFT PELVIS PELVIS
LUNGLUNG
LIVERLIVERABDOMENABDOMEN
SURGERY - RECURRENTSURGERY - RECURRENT
SACRAL ROOT COMPRESSIONSACRAL ROOT COMPRESSION
CAUDA EQUINA SYNDROMECAUDA EQUINA SYNDROMES/P CHEMOTHERAPY S/P CHEMOTHERAPY
ON ADMISSIONON ADMISSION29/11/199929/11/1999
MODERATE GENERAL CONDITION
PULSE: REGULAR, 70 /min,
FULLY ALERT, NORMAL COGNITION
PUPILS: EQUAL, DIAMETER 3mm
AUSCULTATION: FEW CREPITATIONS
ABDOMEN: ABSENCE OF PERISTALTIC SOUNDSLEGS: PITTING OEDEMA IN RT LOWER LIMB 3+
PARTIAL GANGRENE OF LT LEG & FOOT
POSTSURGERY SCAR IN POSTERIOR ASPECT - NAD
BREATHING 18 /min
NEUROLOGICAL: FULLY ALLERT & COOPERATIVE NORMAL COGNITION NORMAL SPHINCTER COMPETENCE MUSCULAR STRENGTH -NORMAL
THE GOALS IN THE INITIAL STAGETHE GOALS IN THE INITIAL STAGE
RAPID PAIN CONTROL WITH ORAL ANALGESISRAPID PAIN CONTROL WITH ORAL ANALGESIS
DISCHARGEDISCHARGEDISCHARGEDISCHARGE
PROBLEMS SOLUTIONS
WEAKNESS BLOOD TRANSFUSIONS (PC)
FATIGUE
DRYNESS OF
THE MOUTHSusp. NYSTATIN
CONSTIPATION LACTULOSE & BISACODYL
3/3
3/3
RESOLVED
DIFFICULT PROBLEMS DIFFICULT PROBLEMS
EPISODES OF DROWSINESS
PAIN - VAS - 10/10
LACK OF AWARENESS ABOUT THE STAGE OF THE DISEASE
PROGNOSIS AND THE TRUE MEANING OF HOSPICE
ADMISSION.
PATIENT NAME: EM ADM. DATE: 0 ID#: ### ASSESSED BY: Dr. M.BNOTES: Mixoid liposarcoma Karnofsky on Admission 0 10 20 30 40 50 60 70 80 90 100
DATEHospital. Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1098
V 7A 6S 5
43210
###
MORPHINE (mg) 140 0 180 0 240 0 125 0 200 0 60
MO Way of Admin. PO PO PO EP EP PO100 100 200 200 100 200 200 50 200 200 240 100 100 280 500 500 100
RESQUE DOSES 150 90 300 200 150 150 200 200 200 240 300 300 100
150 200 150 200 200 125 240 100 300 500
Resque doses PO PO PO PO PO PO PO IM PO PO PO PO PO PO PO PO PO
Way of PO PO PO PO PO PO PO PO PO PO PO PO PO
administration PO PO PO PO IM PO IM PO PO
Sleep (0 - 3) 1 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3Karnofsky (0-100) 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Mobility (0 - 4)3) 40 40 40 40 50
PAIN TYPE BONES NEUROPATHIC VISCERAL OTHER
COANALGESICS NSAIDS ANTIDEPRESANTS ANTICONVULSANTS STEROIDS
Dose (mg)
NEUROGARSEDATIONDRUG CHANGE
AREDIANERVE BLOCKEPIDURALNEUROSURGERY
WHAT TO DO
AFTER UNSUCCESSFUL AFTER UNSUCCESSFUL
PAIN CLINIC INTERVENTIONPAIN CLINIC INTERVENTION
CONSCIOUS SEDATIONCONSCIOUS SEDATION
CORDOTOMYCORDOTOMY
PATIENT,FAMILYPATIENT,FAMILY
IDTIDT
CORDOTOMYCORDOTOMY
FREE OF PAIN WITH GANGRENOUS LLL
FREE OF PAIN WITH AK AMPUTATION
CONSENSUS
STAGING OF THE DISEASE
AMPUTATIONAMPUTATION
WEDDINGWEDDING
REHABILITATION
GERIATRIC
DEPT.
IV ANTIBIOTICS
BEGINNING 0F REHABILITATION
HOSPICE14.01.00 - 21.01.00
DISCHARGE...
PAIN RELIEF
PHYSIOTHERAPY
SEXUAL CONSULTATION
REHABILITATION - PROSTHESIS
MCR 40mg
4.01.01 - 21.07.01
… 7 MONTHS AFTER… 7 MONTHS AFTER
POOR GENERAL CONDITIONSEVERE PAIN IN SPINE AND RT LOWER LIMB
GENERAL WEAKNESS
ABLE TO MOVE IN WHEELCHAIR
PROGRESSIVE GENERAL DETERIORATION
21.07.01
DEATH ….
THE SUCCESSFUL CARETHE SUCCESSFUL CARE
WHAT IS WHAT IS
IN AIN A
PALLIATIVE CARE UNITPALLIATIVE CARE UNIT
THE SUSSCCESSFUL CARE IN PCU IS: THE SUSSCCESSFUL CARE IN PCU IS:
GOOD SYMPTOM CONTROL
GOOD PSYCHOSOCIAL SUPPORT
GOOD SPIRITUAL SUPPORT
SHOULD FACILITATE THE SUCCESSFUL PLANNING SHOULD FACILITATE THE SUCCESSFUL PLANNING
AND ACHIEVEMENT OF THE GOALS OF THE PATIENT AND ACHIEVEMENT OF THE GOALS OF THE PATIENT
AND FAMILY DURING THE TERMINAL PERIOD.AND FAMILY DURING THE TERMINAL PERIOD.
All above
GOOD INTERDISCIPLINARY &
MULTIDISCIPLINARY COLLABORATION