introduction to palliative care alison humphrey clinical nurse specialist in palliative care, sth
TRANSCRIPT
INTRODUCTION TO PALLIATIVE CARE
Alison Humphrey
Clinical Nurse Specialist in Palliative Care, STH
AIMS
To explore development of Palliative Care
Definitions
Where are we now
Service available and how to access them
HISTORY OF HISTORY OF HOSPICE/PALLIATIVE CARE HOSPICE/PALLIATIVE CARE
HISTORY OF HOSPICE HISTORY OF HOSPICE Existed in Roman Times – Charitable institutions for travellersExisted in Roman Times – Charitable institutions for travellers1919thth century religious influence and opened for care of the century religious influence and opened for care of the dyingdying
MODERN HOSPICE CAREMODERN HOSPICE CAREInfluenced by Ciceley SaundersInfluenced by Ciceley SaundersSeparation 1945-1965Separation 1945-1965Transition 1965-1985Transition 1965-1985Incorporation 1985 - presentIncorporation 1985 - present
PALLIATIVE CARE
SUPPORTIVE CARE
END OF LIFE CARE
PALLIATIVE CARE
PALLIATIVE CARE
SUPPORTIVECARE
END OF LIFE CARE
PALLIATIVE CARE
‘Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems physical, psychosocial and spiritual’ (WHO, 2002)
Palliative Care should involve holistic care according to NICE (2004) striving for ‘best quality of life’, ‘applicable earlier in the course of the illness in conjunction with other treatments’ and ‘to help patients to live as actively as possible until death and to help the family to cope during the patient’s illness and in their own bereavement’ (p.20).
SUPPORTIVE CARE
The emphasis of supportive care is to support patients and families ‘during treatment and allowing them to live as well as possible with the effects of the disease’ (NICE, 2004 p.18) and even mentions from diagnosis through to cure as well as to death and bereavement.
This would fit with the cancer survivorship, initiative (DOH, 2007a, 2010); a cancer survivor being : ‘someone who has completed initial treatment and has no apparent evidence of active disease, or is living with progressive disease and may be receiving treatment but is not in the terminal phase of illness, or someone who has had cancer in the past’ (Corner, 2007).
Long Term Conditions
END OF LIFE CARE
End of Life Care Strategy (2008) has the aim of allowing patients to ‘live as well until they die throughout the last phase of life and into bereavement’.
The last phase considered to be last 12 months of life.
Advanced Care Planning
Amber Bundles
EMPHASIS ON END OF LIFE CARE
One in 10 patients die during their hospital stay
Chris Smyth The Times Published: 19 March 2014
Liverpool care pathway review shows challenges in palliative care Melanie Henwood Guardian Professional, Tuesday 23 July 2013
Neuberger Report, 2013
Francis Report, 2013
GENERAL PALLIATIVE CARE
‘General palliative care is the level of palliative care which should be provided by all healthcare professionals, in primary or secondary care, within their duties to patients with life-limiting disease’
SPECIALIST PALLIATIVE CARE
Holistic and multidisciplinary approach
MDT consist of Doctors, Nurses, Social Worker, Therapists, Chaplain, Complementary Therapies
Provided at the expert level, by a trained, multi-professional team in order to manage persisting, sever or complex problems
UUncontrolledComplex
Symptoms
PsychologicalEmotional
IssuesRelated to illness
Complex Social Issues
PsychospiritualIssues
REFERRAL CRITERIA
End of Life care
REFERRALS NOT MEETING CRITERIA
Condition inactive
and stable
Long term care
Palliative Package of
care
Respite
Chronic
Pain
SERVICES AVAILABLE IN STH
Hospital Support Team consisting of Consultant, Registrar and Clinical Nurse Specialists
Macmillan Palliative Care Unit – 18 bedded inpatient unit
Outpatient clinics run by Consultants and Registrars
Community Visits
Complex Case Management
COMMUNITY TEAM SERVICES IN SHEFFIELD
Community Specialist Palliative Care Team consisting mainly of Clinical Nurse Specialists with access to Consultant and Registrar Support
St Luke’s Hospice Inpatient Centre – 20 bedded unit
Therapies and Rehabilitation Centre – Day Care
OUT OF HOURS
Community – Contact St Luke’s main switchboard.
STH Palliative Care CNS Team providing seven day, 9-5 service
STH after 5pm – Contact switchboard who will contact Registrar on call for Palliative Care
HOW TO REFER
REFERRAL FORM
REFERRAL FORM
HOW REFERRAL IS PROCESSED FOR COMMUNITY SERVICES AND INPATIENT UNIT
REFERRAL TO HOSPITAL SUPPORT TEAM
Referrals reviewed by Palliative Care CNS
Referrals prioritised
Visit ward
REFERENCES
CORNER, Jessica (2007) Making the National Cancer Survivorship Initiative a Reality powerpoint presentation at Britain against Cancer Conference London http://www.macmillan.org.uk/Documents/GetInvolved/Campaigns/Campaigns/APPG/brita accessed
DEPARTMENT OF HEALTH, MACMILLAN CANCER SUPORT AND NHS IMPROVEMENT (2010) National Cancer Survivorship Initiative (NCSI) Vision. London, Crown
DEPARTMENT OF HEALTH (2008) End of Life Care Strategy - Promoting high quality care for all adults at the end of life. London, Crown
DEPARTMENT OF HEALTH (2013) MORE CARE,LESS PATHWAY A REVIEW OF THE LIVERPOOL CARE PATHWAY
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE (2004) Improving Supportive and Palliative Care for Adults with Cancer London, National Institute for Clinical Excellence
Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry www.midstaffspublicinquiry.com
The AMBER Care Bundle Design Team (2011) www.ambercarebundle.org
WORLD HEALTH ORGANISATION (2002) WHO Definition of Palliative Care http://www.who.int/cancer/palliative/definition/en/