Achieving Excellence in Hospice Palliative Care

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Achieving Excellence in Hospice Palliative Care

 

• Breakfast of Champions
• Date September, 22, 2006

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Bayshore Home Health

• Bayshore Home Health
• Operating since 1966
• 37 locations across Canada
• Over 5,000 Nurses and Personal Support Workers
  nationally
• Fully Canadian-owned

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Achieving Excellence in Hospice Palliative Care

• Bayshore Home Health developed and implemented
  Hospice Palliative Care (HPC) Clinical Pathway
  protocols, incorporating The Canadian Hospice
  Palliative Care Associations(CHPCAs) Model to
  Guide Hospice Palliative care and the Provincial
  Palliative Care Integration Project.
• Goal to create clinical tools that supported
  nurses in evidence based practice.

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Background

• In 2005, Bayshore Home Health adopted the
  development of a Hospice Palliative Care program
  as one of its primary national clinical goals.
• Bayshore Home health adopted the CHPCAs A Model
  to Guide Hospice Palliative Care Standards and
  Norms of Practice
• Clinical pathways identified as tools which
  would provide more structured decision support
  and a documentation system for our nurses.

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Bayshores Model
Bayshores C.A.R.E. Model
Based upon A Model to Guide Hospice Palliative
Care (CHPCA, 2002)
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Program Objectives

• To improve processes of hospice palliative care
  nursing/home support services.
• To integrate our Pathway protocols with
  Provincial Palliative Care Integration Project
  and best practice evidence.
• To undertake a planned systematic implementation
  that incorporates quality improvement measures.

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Hospice Palliative Pilot

• Pilot Implementation Plan (8 months)
• Stakeholder Presentation
• Branch Manager Champion
• Front-line Change Agents
• Nursing HPC Pathway Training Program
• Nursing HPC education support
• Sustainability Plan

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Hospice Palliative Clinical Pathways

• Hospice Palliative Care Pathway Phases
• Phase 1 (Stable) PPS 100 to 70
• Phase 2 (Transitional) PPS 60 to 40
• Phase 3 ( End-of-Life) PPS 30 to 0
• Phase 4 (Final Client Visit)
• Phase 5 ( Bereavement)

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Integration/Collaboration

• Provincial Palliative Care Integration
  Project(PPCIP)
• ESAS (Edmonton Symptom Assessment Scale)
• Palliative Performance Scale (PPSv2)
• Dyspnea scale and the Oxygen Cost Diagram
• Braden scale
• Collaborative Care plans
• Symptom Management Guidelines

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Quality Improvement

• Program and Client Outcome Evaluation
• Goals Met/Not Met
• Client Satisfaction
• Clinical Pathways chart audit
• Pre/Post Surveys (CCAC case managers, nurses)

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Challenges

• Change management
• Documentation
• Consistently collecting and collating outcome
  measures
• Sustainability

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Successes

• Opportunity to integrate LHIN mandate. Engage
  the community in new ways that promote
  integration and collaboration Charles Beer,
  Principal with counsel Public Affairs.
• System in place allowing Bayshore to focus on
  improving client/patient outcomes at the bedside.
• Positive stakeholder interest

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Next Steps

• Continue collect and collate pilot data
• Complete revisions
• Roll out revised pathways at clinical conference
• Identify Mentors
• Focus on implementation at the bedside
• Questions????

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References

• Bookbinder, M, (2001). Improving quality end of
  care across all settings, In Palliative
• Nursing, (eds) BR Ferrell and N Coyle, Oxford,
  New York pp. 503-530.
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• 2. Bayliss, V, Salter, L. (2004) Pathways for
  evidence based continence, Nursing
• Standard, 19(9), pp 45-52, 54, Retrieved from
  Ovid database, April 2006
•  
• 3. Luhrs, LA, Meghans, S, Homel, P, Drayton, M,
  OToole, E, Paccione, M, Daratsos, L,
• Wollner, D, Bookbinder, M. (2005) Pilot of a
  pathway to improve the care of the imminently
  dying, Journal of Pain and Symptom Management,
  29(6), pp 544-551, Retrieved form CINAHL
  database, April 2006.
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• 4. VNA First. (2005). Evidence based processes
  and resources. VNA FIRST Home Care Steps?
  Protocols for Palliative Care. Illinois
  Innovative Healthcare
• Solutions Inc.
•  
• 5. Canadian Hospice Palliative Care Association.
  (2002). A model to guide
• hospice palliative care Based on National
  Principles and Norms of Practice.
•  
• 6. Palliative Care Integration Project. (2003)
  Palliative care Integration project,
• Resource manual, (1st ed.), Available from,
• http//meds.queensu.ca/palcare/PCIP/PCIPHome.htm
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