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Palliative Care & End of Life Integris health. 100 Years Ago.

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Presentation on theme: "Palliative Care & End of Life Integris health. 100 Years Ago."— Presentation transcript:

1 Palliative Care & End of Life Integris health

2 100 Years Ago

3 The Last 100 Years Industrialization & Modern Medicine Life Expectancy 47.5 yrs yrs. Causes of Death Primarily Infectious Primarily Chronic Illnesses Disease Trajectory ShortExtended Medical Focus ComfortCure CaregiversFamily Health Care Providers Site of Death Home Hospitals & Nursing Homes Death Rate 1720 per 100, per 100,000

4 The Last 100 Years In 1900, the average life span was 47.5 years In 1900, the average life span was 47.5 years Leading Causes of Death Leading Causes of Death Pneumonia Pneumonia Tuberculosis Tuberculosis Diarrhea & Enteritis Diarrhea & Enteritis Heart Disease Heart Disease Stroke Stroke Liver Disease Liver Disease Injuries Injuries Cancer Cancer Senility Senility Diptheria Diptheria In 2000, the average life span was 76.5 years In 2000, the average life span was 76.5 years Leading Causes of Death Leading Causes of Death Heart Disease Cancer Stroke Chronic Lung Disease Pneumonia Accidents Diabetes Suicide Kidney Disease Chronic Liver Disease

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6 End of Life Statistics In 1997, most Americans died in one of three settings: In 1997, most Americans died in one of three settings: Hospitals 53%Nursing Homes 24% Home 23% Most people surveyed preferred to die at home and pain free however, Most people surveyed preferred to die at home and pain free however, 77% died in institutions 77% died in institutions 50% died in pain (SUPPORT I) 50% died in pain (SUPPORT I) The number of people over 85 will double to 9 million by the year 2030 (CDC) The number of people over 85 will double to 9 million by the year 2030 (CDC) Forty percent of all DNRs are signed within 48 hours of death Forty percent of all DNRs are signed within 48 hours of death

7 Mission Statement At INTEGRIS Health, our Palliative Care Service Mission is: At INTEGRIS Health, our Palliative Care Service Mission is: To improve the quality of life of the people and community we serve. We believe this mission extends to all stages of life. Accordingly, we believe in palliative care as a process to meet the needs of persons with chronic, life-limiting illnesses. Palliative care assists with pain and symptom relief; with education and support for patients and their family; and with transitions in care as the illness progresses. To improve the quality of life of the people and community we serve. We believe this mission extends to all stages of life. Accordingly, we believe in palliative care as a process to meet the needs of persons with chronic, life-limiting illnesses. Palliative care assists with pain and symptom relief; with education and support for patients and their family; and with transitions in care as the illness progresses.

8 What Is Palliative Care? Palliative Care is: Palliative Care is: Quality medical care for those with a life-limiting or life-threatening illness Quality medical care for those with a life-limiting or life-threatening illness Pursuing the goals as defined by the patient Pursuing the goals as defined by the patient Guiding patients/families as care transitions from curative therapy to disease & symptom management Guiding patients/families as care transitions from curative therapy to disease & symptom management Addressing the patients needs in context of their own social system Addressing the patients needs in context of their own social system Prevention, assessment and treatment of pain and other physical, psychosocial and spiritual problems Prevention, assessment and treatment of pain and other physical, psychosocial and spiritual problems

9 Why Palliative Care? Palliative Care is an option for anyone with: Palliative Care is an option for anyone with: A life-limiting illness that includes the cascade of physical, emotional, psychosocial and spiritual needs A life-limiting illness that includes the cascade of physical, emotional, psychosocial and spiritual needs A need to relieve suffering A need to relieve suffering Feelings of isolation Feelings of isolation Feelings of being less than a person (the disease has become their primary focus in life) Feelings of being less than a person (the disease has become their primary focus in life) A need for aggressive symptom management A need for aggressive symptom management A need to maximize their quality of life A need to maximize their quality of life

10 Who Provides Palliative Care? A multidisciplinary team of palliative care professionals – MD, RN, MSW, Chaplain in collaboration with the primary physician, nurses, healing touch therapists, pharmacist, dietician and all staff who provide care to this patient and family A multidisciplinary team of palliative care professionals – MD, RN, MSW, Chaplain in collaboration with the primary physician, nurses, healing touch therapists, pharmacist, dietician and all staff who provide care to this patient and family The Palliative Care Team provides consult services to in-patients with complex palliative care needs identified through the palliative care screening process The Palliative Care Team provides consult services to in-patients with complex palliative care needs identified through the palliative care screening process Every care provider has responsibility to address the palliative care needs of our patients Every care provider has responsibility to address the palliative care needs of our patients

11 What Services Are Provided? Pain and symptom management Pain and symptom management Coordination of health care services Coordination of health care services Disease process information Disease process information Community resource information Community resource information Spiritual support Spiritual support Assistance with communication and decision- making Assistance with communication and decision- making Setting care goals that expand throughout the progression of illness Setting care goals that expand throughout the progression of illness

12 What It Is and Is Not Palliative care is: Expert care of pain and symptoms throughout illness Expert care of pain and symptoms throughout illness Communication and support for decision making Communication and support for decision making Attention to practical support and continuity across settings Attention to practical support and continuity across settings Care that patients want at the same time as efforts to cure or prolong life Care that patients want at the same time as efforts to cure or prolong life Palliative is not: Palliative is not: giving up on the patient What we do when there is nothing more we can do In place of curative or life- prolonging care The same as hospice

13 Palliative Care Vs. Hospice Palliative Care Available while patient still receiving life prolonging or life saving therapies Available while patient still receiving life prolonging or life saving therapies Begins much earlier in disease trajectory Begins much earlier in disease trajectory Disease treating professionals continue consulting services Disease treating professionals continue consulting services Hospice Care Those in hospice always receive palliative care, but hospice focuses on a persons final months of life Those in hospice always receive palliative care, but hospice focuses on a persons final months of life Team oriented approach to enhance comfort and improve quality of life with such therapies as symptom management, emotional, spiritual and bereavement support for the patient and families Team oriented approach to enhance comfort and improve quality of life with such therapies as symptom management, emotional, spiritual and bereavement support for the patient and families

14 Symptom Management Pain Pain Nausea Nausea Vomiting Vomiting Shortness of Breath Shortness of Breath Lack of appetite Lack of appetite Anxiety Anxiety Depression Depression Fatigue Fatigue Drowsiness Drowsiness

15 Alert vs. Nonresponsive Patients who are alert or responsive should be able to participate in their own treatment as much as possible Patients who are alert or responsive should be able to participate in their own treatment as much as possible Nonverbal cues Nonverbal cues Grimacing Grimacing Moaning Moaning Restlessness Restlessness Elevated blood pressure and/or heart rate Elevated blood pressure and/or heart rate Subtle cues interpreted by family Subtle cues interpreted by family

16 Symptom Management Expect the presence of multiple symptoms Expect the presence of multiple symptoms All symptoms can have their severity measured with a simple scale of 1 – 10. All symptoms can have their severity measured with a simple scale of 1 – 10. Symptom severity is best scored by the patient. If the patient is unable, the family or nurse may be ask to provide a score. Symptom severity is best scored by the patient. If the patient is unable, the family or nurse may be ask to provide a score. Measuring and recording symptom severity over time allows interventions to be adjusted and maximizes comfort and quality of life. Measuring and recording symptom severity over time allows interventions to be adjusted and maximizes comfort and quality of life. The goal of symptom management is to control symptoms, promote meaningful interactions between patients and significant others and facilitate peaceful deaths. The goal of symptom management is to control symptoms, promote meaningful interactions between patients and significant others and facilitate peaceful deaths.

17 Symptom Management & The Family The dying patients family is often viewed as a third leg of a triad much like in pediatrics The dying patients family is often viewed as a third leg of a triad much like in pediatrics Patients and family members often have different stresses and are at different stages of grieving – leading to additional stresses and issues within the family Patients and family members often have different stresses and are at different stages of grieving – leading to additional stresses and issues within the family Denial Denial Bargaining Bargaining Anger Anger Depression Depression Acceptance Acceptance Anticipatory Grief Anticipatory Grief

18 Death & Family Dynamics (Dys) Functional Family Roles (Dys) Functional Family Roles ITWBBTCI - YAGFTH ITWBBTCI - YAGFTH Previous family issues, old baggage, that were never resolved or dealt with Previous family issues, old baggage, that were never resolved or dealt with Marital issues Marital issues Abuse issues Abuse issues Parent-child issues Parent-child issues Estranged relationships Estranged relationships

19 Education Patients and Family Members usually have little or no health care training Patients and Family Members usually have little or no health care training Disease Process Disease Process Disease Trajectory Disease Trajectory Treatment Options Treatment Options Treatment Goals Treatment Goals Resources & Support for Patient and Family Resources & Support for Patient and Family

20 Spiritual Aspects Spiritual Distress by the patient may actually exacerbate physical symptoms Spiritual Distress by the patient may actually exacerbate physical symptoms Some cultures had specific rituals or beliefs dealing with death and dying such as Last Rights or bathing after death Some cultures had specific rituals or beliefs dealing with death and dying such as Last Rights or bathing after death

21 Hospital Resources Clinical Support Clinical Support Nursing Nursing Physician Physician Pharmacy Pharmacy Case Management Case Management Social Work Social Work Pastoral Care Pastoral Care Ethics Committee Ethics Committee

22 The Legal Forms Advanced Directive (AD) Advanced Directive (AD) Living Will for Health Care Living Will for Health Care Health Care Proxy Health Care Proxy Durable Power of Attorney for Healthcare (DPOA) Durable Power of Attorney for Healthcare (DPOA) Do Not Resuscitate (DNR) Do Not Resuscitate (DNR) Certificate of Physician Certificate of Physician

23 Postmortem Care Is the care provided to the patients body after their death. Is the care provided to the patients body after their death. Postmortem care is necessary to keep the body in proper alignment and prevent skin damage and discoloration Postmortem care is necessary to keep the body in proper alignment and prevent skin damage and discoloration Cultural and religious beliefs often dictate how the body is to cared for after death and by whom. Cultural and religious beliefs often dictate how the body is to cared for after death and by whom. In some cultures the family members help to clean and prepare the body. In some cultures the family members help to clean and prepare the body.

24 Postmortem Care Standard precautions are followed. Standard precautions are followed. The body is placed in proper alignment before rigor mortis occurs The body is placed in proper alignment before rigor mortis occurs Position the body: Position the body: Place the patient in center of bed with a pillow under the head. Place the patient in center of bed with a pillow under the head. Close the eyes. Put a moistened cotton ball on each eyelid if the eyes do not stay closed. Close the eyes. Put a moistened cotton ball on each eyelid if the eyes do not stay closed. Replace the patients dentures Replace the patients dentures

25 Postmortem Care Cleans the body. Often times the patient will loose control of bowl and bladder. Cleans the body. Often times the patient will loose control of bowl and bladder. Place a clean gown, sheets and blanket. Place a clean gown, sheets and blanket. Remove any trash or clutter from the room. Put bed in lowest position with all four side rails down. Move chairs around bed and have a box of tissue within reach. Remove any trash or clutter from the room. Put bed in lowest position with all four side rails down. Move chairs around bed and have a box of tissue within reach. Allow the patients family enter the room. Allow the patients family enter the room.

26 Postmortem Care After the patients family leaves the funeral home will be notified. After the patients family leaves the funeral home will be notified. If there is not a bed crunch the patient may stay in the room until the funeral home can come and pick the patient up. If there is not a bed crunch the patient may stay in the room until the funeral home can come and pick the patient up. If there is a need for the room or if the funeral home will not be able to come for several hours the patient may have to go to the morgue. If there is a need for the room or if the funeral home will not be able to come for several hours the patient may have to go to the morgue. If you have to take the patient to the morgue: If you have to take the patient to the morgue: Call security and ask them to meet you at the morgue. Call security and ask them to meet you at the morgue. Transport the body to the morgue. Security will have to unlock the door and then relock after you place the body in the morgue. Transport the body to the morgue. Security will have to unlock the door and then relock after you place the body in the morgue.

27 Postmortem Care Postmortem Care for patients going to the Medical Examiner Postmortem Care for patients going to the Medical Examiner Do everything that you would normally do except: Do everything that you would normally do except: Do not remove any tubes (foley, NG, Vent, etc) or IV/lines. Do not remove any tubes (foley, NG, Vent, etc) or IV/lines. These will go with the patient to the MEs office. These will go with the patient to the MEs office. Patients who might go to the MEs Office: Patients who might go to the MEs Office: Patients who die within 24 hours of admission Patients who die within 24 hours of admission Injuries/death the result of violence (ie gang, domestic, robbery, etc) Injuries/death the result of violence (ie gang, domestic, robbery, etc) Death result of an automobile accident Death result of an automobile accident


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