palliative care orientation presentation at 27 may 2010 (1)
TRANSCRIPT
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Palliative Care InPalliative Care In
The Acute SettingThe Acute Setting
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AimsAims To provide participants with a definition ofTo provide participants with a definition of
palliative carepalliative care
Define the key palliative care serviceDefine the key palliative care serviceproviders across all settingsproviders across all settings
To understand the importance of applying aTo understand the importance of applying apalliative care approach to your carepalliative care approach to your care
Highlight further supportHighlight further support
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PalliativePalliative CareCare isis anan approachapproach thatthat improvesimprovesthethe qualityquality ofof lifelife ofof patientspatients andand theirtheir
familiesfamilies facingfacing thethe problemsproblems associatedassociated withwithlifelife--threateningthreatening illness,illness, throughthrough thethepreventionprevention andand reliefrelief ofof sufferingsuffering byby meansmeans
ofof earlyearly identificationidentification andand impeccableimpeccableassessmentassessment andand treatmenttreatment ofof painpain andand otherotherproblems,problems, physicalphysical,, psychologicalpsychological andandspiritualspiritual.. (WHO(WHO 20032003))
What is Palliative care
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The Philosophy of NursingThe Philosophy of Nursing Patient centredPatient centred
approachapproach
PartnershipPartnership
Holistic approachHolistic approach
RespectRespect
Promotion ofPromotion ofcomfort and dignitycomfort and dignity
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The Philosophy of PalliativeThe Philosophy of Palliative
CareCare
Patient centred approachPatient centred approach
PartnershipPartnership Holistic approachHolistic approach
RespectRespect
Promotion of comfort and dignityPromotion of comfort and dignity
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Essential Components ofEssential Components of
Palliative CarePalliative Care Effective communicationEffective communication
Symptom controlSymptom control
RehabilitationRehabilitation
Education and trainingEducation and training
Research and auditResearch and audit
Continuity of careContinuity of care Terminal careTerminal care
Bereavement supportBereavement support
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chaplain
Hospices
Pysio/SALTS/
OT/Dietician
Pharmacist
Hospital
Team
Social workDentist
Marie Curie
(overnight
care)
District Nurse
GP
Palliative
Clinical Nurse
Specialist
Family / Carers
Palliative Care in Hospitals is supportedPalliative Care in Hospitals is supportedby alarge multiby alarge multi--disciplinary Teamdisciplinary Team
Palliative Care Practice
Development Team
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ToTo support patientssupport patients with palliative carewith palliative careneedsneeds
ToTo support carerssupport carers of patients withof patients withpalliative care needspalliative care needs
ToTo supportall staffsupportall staff to deliver qualityto deliver qualitypalliative care to patientspalliative care to patients
ToTo review patients and support staffreview patients and support staffwith complex physical and emotionalwith complex physical and emotionalsituationsituation
ToTo provideprovide educationeducation to patients, carersto patients, carersand colleaguesand colleagues
To advance the practice of palliative careTo advance the practice of palliative carewithwith research and auditresearch and audit
The Role of Hospital
Palliative Care Teams
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Where are we nowWhere are we now 6 Hospices within GG&C6 Hospices within GG&C
Palliative care teams introduced into thePalliative care teams introduced into the
Acute Care Setting early 2000Acute Care Setting early 2000 Links with Hospices and Care HomesLinks with Hospices and Care Homes
commissioned postscommissioned posts
Challenges for equitable access toChallenges for equitable access toservices for all no matter age, culture,services for all no matter age, culture,and diagnosisand diagnosis
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Epidemiology, ScotlandEpidemiology, Scotland
27,400 new cancers in 200727,400 new cancers in 2007
100,000 living with heart failure (2008)100,000 living with heart failure (2008)
10,500 MS (2009) 1:500 one of highest per capita in10,500 MS (2009) 1:500 one of highest per capita in
the worldthe world Approx 120, 000 living with Parkinsons DiseaseApprox 120, 000 living with Parkinsons Disease
(2010)(2010)
350 MND (2008/09) increase from 280350 MND (2008/09) increase from 280
90,000 live with COPD (one of the highest rates in90,000 live with COPD (one of the highest rates inEurope)2009Europe)2009
58,00058,000 -- 65,000 dementia predicted to rise to65,000 dementia predicted to rise to100,000 by 2031(Living and Dying Well. 2008)100,000 by 2031(Living and Dying Well. 2008)
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Numbers and Place of DeathNumbers and Place of DeathNHS Scotland v Greater Glasgow and ClydeNHS Scotland v Greater Glasgow and Clyde
TotalTotal 55,70055,700 TotalTotal 13,68813,688
TOTAL -13,688
57%20%
23%
Hospital
Other Inst
Non Inst58%
19%
23%
Hospital
Other Inst
Non Inst
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Causes of death GGC 2008Causes of death GGC 2008 --Top 5Top 5No. ofNo. ofdeathsdeaths HospitalHospital OtherOtherinstitutioinstitutio
nn
NonNoninstitutioinstitutionn
All deathsAll deaths 13,68813,688 57%57% 20%20% 23%23%
Ischemic HeartIschemic HeartDiseaseDisease
2,0722,072 47%47% 10%10% 43%43%
CerebrovascularCerebrovascularDiseaseDisease
12741274 64%64% 25%25% 11%11%
Ca bronch, lung,Ca bronch, lung,tracheatrachea
11701170 48%48% 27%27% 25%25%
Chronic LowerChronic Lowerrespiratoryrespiratory
775775 71%71% 10%10% 19%19%
Dementia &Dementia &AlzheimersAlzheimers
723723 35%35% 61%61% 4%4%
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No. ofNo. ofdeathsdeaths
HospitalHospital OtherOtherinstitutioinstitutio
nn
NonNoninstitutioinstitutio
nn
All deathsAll deaths 1368813688 57%57% 20%20% 23%23%
Influenza andInfluenza andpneumoniapneumonia
675675 71%71% 21%21% 8%8%
Cirrhosis and otherCirrhosis and otherliverliver
445445 72%72% 2%2% 26%26%
Ca colon etcCa colon etc 384384 39%39% 33%33% 28%28%
Urinary diseaseUrinary disease 310310 78%78% 17%17% 5%5%
Ca breastCa breast 247247 40%40% 38%38% 22%22%
Causes of death GGC 2008 - 6-10
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Policy context - Scotland
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Tools/triggers to identifyTools/triggers to identifyneedsneeds
Assessment toolsAssessment tools
Palliative care for allPalliative care for allincluding elderly and LTCincluding elderly and LTC
Primary care registersPrimary care registers
Just in case boxesJust in case boxes
Service info directoriesService info directories Lothian DNACPR policyLothian DNACPR policy
24 hour community24 hour communitynursingnursing
Access to equipmentAccess to equipment Processes to enable safeProcesses to enable safe
transfertransfer
Education championEducation champion
Work with voluntaryWork with voluntarysectorsector
The plan
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The Current PrioritiesThe Current Priorities GSF to encompass all patients withGSF to encompass all patients with
palliative care diagnosispalliative care diagnosis
Liverpool Care Pathway (LCP)Liverpool Care Pathway (LCP)
DNACPRDNACPR
Advance Care PlanningAdvance Care Planning
Adoption of Lothian SMGAdoption of Lothian SMG
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Balancing PrioritiesBalancing Priorities Essential careEssential care
Palliative CarePalliative Care
DocumentationDocumentation
Workforce planning/developmentWorkforce planning/development
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Palliative and end of life care will always bePalliative and end of life care will always bepart of our role in hospitals so we have to bepart of our role in hospitals so we have to be
able to deliver effectivelyable to deliver effectively We have to be able to assess and listen toWe have to be able to assess and listen to
patients and families who are living with lifepatients and families who are living with lifelimiting illness from the time of the diagnosislimiting illness from the time of the diagnosis
We must be able to deliver care which isWe must be able to deliver care which isholisticholistic and meets the needs identified byand meets the needs identified bypatients and familiespatients and families
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Further Help and SupportFurther Help and Support Palliative Care ModulesPalliative Care Modules
Liverpool Care Pathway Champions SupportLiverpool Care Pathway Champions SupportProgrammeProgramme
Use of subcutaneous medication in palliative careUse of subcutaneous medication in palliative care
Mckinley Pump TrainingMckinley Pump Training
Palliative Care resource foldersPalliative Care resource folders
Respond to any enquires regarding practiceRespond to any enquires regarding practice
ACPACP
DNACPRDNACPR
LSMGLSMG
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Final Thoughts!Final Thoughts!
You matter because you are you,You matter because you are you,and you matter untilthe lastand you matter untilthe lastmoment of yourlife. We will do allmoment of yourlife. We will do allwe can not only to help you diewe can not only to help you die
peacefully butalso to live until youpeacefully butalso to live until youdiedie