PALLIATIVE CARE STANDARDS

1
PALLIATIVE CARE STANDARDS

• Urska Lunder
• Carl Johan Fürst
• Sylvia Sauter
• Budapest, Oct 16-18, 2003

2
AIM

• review existing documents on standards
• get a deeper understanding of quality indicators
• standards and perspectives used for quality
  improvement
• common minimal standards

3
INTRODUCTION

• Standards - to assureand improve quality of care
• Increasing need to establish indicators of
  quality and effectiveness in palliative care
• Definitions, goals and design often different and
  sometimes unclear

4
METHODS

• Collection of existing standards documents (from
  different organizations, committees,
  associations, nations, etc.)
• E-mailed letter to all collective members of EAPC
• Newsletter of EAPC-east (Call for standards)
• Personal contacts
• Web site searching

5
Terminology

• Essential criteria A criterion that should be
  met wherever a service is provided
• Guidelines Systematically developed statements,
  which assist in decision making about appropriate
  healthcare intervention for specific clinical
  condition

6
Terminology

• Norm Statement for average practice. Less rigid
  than a standard
• Principle A fundamental truth

7
Terminology

• Standard Statement that defines a required or
  essential condition to be achieved or maintained
  a state of being, not an activity

8
www.eapceast.org

• Australia
• Canada Norms of Practice for Practice for Hospice
  Palliative Care
• Canada Hospice Palliative Care Nursing Standards
  of Practice
• Hungary
• Italy
• Moldova
• Poland
• Romania
• Scotland Specialist Palliative Care
• Scotland Hospice Care

9
www.eapceast.org

• Spain
• Switzerland
• Trent Hospice Audit Group
• United States of America Hospice Standards of
  Practice
• United States of America Standards of Practice
  for End-of-life Care
• United States of America Health Care Organisation
  Guidelines
• Wales

10
METHODS

• Selected documents were analysed according to
• Content
• Structure
• Perspective
• Aspect of use

11
CONTENT DOMAINS AND ASPECTS

• Target group
• values and philosophy
• managing people / resources

12
CONTENT DOMAINS AND ASPECTS

• Physical
• psychosocial
• spiritual
• bereavement

13
CONTENT DOMAINS AND ASPECTS

• Info sharing process
• process of providing care
• documentation
• monitoring system
• education
• quality improvement

14
STRUCTURE

• structure
• process
• outcome
• audit
• accreditation
• certification

15
PERSPECTIVE OF STANDARDS

• adults
• children
• service providers
• one profession
• process oriented

16
DISCUSSION

• Provide criteria, measurable in different
  settings.
• Applicable to all patients, including
  non-malignant disease.
• Few include paediatric palliative care.
• Few have proposed practical assessment tools for
  peer review or audit.

17
DISCUSSION

• Evaluation of the impact of standards not made.
• Serve as an agent for change, in the.direction
  of improved care
• Not a comprehensive listing ofall national
  guidelines, standards and policies.

18
DISCUSSION

• Our evaluations may serve as basis for further
  discussion.

19
CONCLUSIONS

• Great variations concerning aims, target groups,
  areas covered and structure.
• No clear common format for a standard.
• Terminology is often unclear and confusing.
• Remarkable work done in producing

20
FUTURE AIMS

• Increase quality of care for dying patients.
• Basic standard format for PC.
• Including an audit tool.
• Framework for national and international
  standards in palliative care.
• Definition of minimum standards for palliative
  care services as a highest priority.