VICTORIA HOSPICE & PALLIATIVE CARE

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1 D R. G. M I C H A E L D OWNING C L I N I C A L A S S O C I AT E P R O F E S S O R PA L L I AT I V E M E D I C I N E D I R E C T O R O F R E S E A R C H & D E V E LO P M E N T V I C T O R I A H O S P I C E, C A N A D A VICTORIA HOSPICE & PALLIATIVE CARE C H I A N G M A I, T H A I L A N D, J u n e 1 8 th 2010

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4 VICTORIA HOSPICE

5 VICTORIA HOSPICE PROGRAM Palliative Care Unit (PCU) Home program Home Nursing Palliative Response Team (PRT) Medical Consultation Psychosocial & Spiritual Volunteers Bereavement Education and Training Research Fund-Raising Statistics

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7 DOCTOR S & NURSES

8 Palliative Medicine Physicians at Victoria Hospice Dr. Jim Wilde Dr. Fraser Black, Medical Director Medical student Dr. Christine Jones

9 Angela, Tracy, Collette Some Palliative Care Unit Nurses Thea Linda Cliff Manager of Palliative Nursing

10 17 BED PALLIATIVE CARE UNIT

11 Elevators to Palliative Care Unit

12 Wall beside the Elevators

13 UNIT Reception Area

14 UNIT Ward Clerks

15 1 st Patient & Family Lounge

16 Patient & Family Refreshment Area Fridge Microwave Coffee

17 2 nd Patient & Family Lounge Internet for family

18 Family Conference Room

19 Hallway of UNIT

20 Patient Bedroom Ceiling Lift electric

21 Patient Bedroom Sitting & Sleeping Area for Family

22 Patient Bedroom TV and Fridge

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24 Unit Rounds Room Nurse Team assignments Patient Names

25 Room # PPS % Bed Type Family Doctor Mrs. L Mrs. S Mrs. E Miss. J Mr. B Miss B Mr. J Patient Name Room # 311 Mrs. S. with PPS 50% Admitted to A Acute palliative bed Reason: metastatic cancer breast with severe lumbar bone pain

26 Kirsten Music Therapist Joan - Clinical Nurse Educator Michelle Counsellor Jill Unit Nurse Ryan Palliative Medicine Morning Rounds

27 Medication Room Nurse Phin sets PAIN PUMP Drug Cart

28 Palliative Care Unit Supply Room

29 Art on Ward Walls Done by Volunteers

30 ROOFTOP HOSPICE GARDEN

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33 PALLIATIVE RESPONSE TEAM (PRT) MEDICAL & NURSING C ARE

34 PALLIATIVE RESPONSE TEAM (PRT) 24 hour response to homes Purpose: Short term [LOS average 3.5 days] Crisis symptom control Support death at home, in addition to Home Nurse and Family Physician Team Nurses 12-hour shifts x2 Counsellors day and evening Pall. Physician

35 Palliative Response Team (PRT) Room Patient Names on PRT at home today PPS 40% PPS 40% PPS 10% PPS 0% PPS 0% Priority of visits to do

36 PRT Morning Rounds Doctor Counsellor Medical student PRT Nurse PRT Nurse Leader

37 PRT Vehicle Provided by Hospice Drive team Carry supplies & drugs Statistics PRT Nurse 12 hour shifts, 7 days per week Average # patients per day 3-5 Total # cases per year 500 Average LOS 3.5 days Results in low Emerg visits 80% stay home; 15% to PCU; 5% to Emerg.

38 PRT Drug Kit Drug Kit left in each home while on PRT Drugs accessed by PRT nurse, home nurse or Family Doctor

39 PRT DRUG KIT & CAR CONTENTS Oral, supp and injectable meds for Pain Nausea Anxiety Delirium Laxatives, enema Seizures Respiratory secretions Bladder spasm Diuretic Steroid [see next page] Other supplies Gloves Swabs Syringes Skin care pads IV bags for hypodermoclesis Small suction machine Small oxygen

40 MUSIC THERAPY K I RSTEN DAVI E S

41 Music Therapist (Kirsten) sings with a patient of songs she would like to hear or sing along with

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43 COUNSELLORS

44 COMMUNITY & UNIT COUNSELLORS

45 BEREAVEMENT COUNSELLORS

46 SPIRITUAL CARE

47 Lamp in ward hallway turned on for 24 hours when a patient dies, and a memory card We turn the light on You might light a candle Light on for family; also, information for staff

48 SPIRITUAL REFLECTION ROOM Examples of ritual items in the room for patient or family to meditate

49 VOLUNTEERS

50 VOLUNTEER TALKS WITH PATIENT AND HELPS WITH WRITING LETTER 58 year old mother with breast cancer and brain metastases. Use of steroid causes swollen face

51 Volunteer looks after family puppy while patient has a bath. Families can bring in animals for visiting. Pets are often part of good pain control for patients.

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53 Daughter sits with her Mom who has lung cancer. Her PPS 10% and now close to death. Her family dog sleeps beside her to give comfort.

54 PALLIATIVE PERFORMANCE SCALE (PPSV2)

55 Palliative Performance Scale (PPSv2) PPS 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Ambulation Activity & Self-Care Intake Conscious Evidence of Disease Level Full Normal Activity Full Normal Full No Evidence of Disease Full Normal Activity Full Normal Full Some Disease Full Normal Activity with Effort Full Normal or Full Some Disease Reduced Reduced Unable Normal Job/Work Full Normal or Full Some Disease Reduced Reduced Unable Hobby/House Work Occasional Normal or Full Significant Disease Assistance Reduced +/- Confusion Mainly Sit/Lie Unable to Do Any Work Considerable Normal or Full Extensive Disease Assistance Reduced +/- Confusion Mainly in Bed Unable to Do Any Work Mainly Normal or Full or Drowsy Extensive Disease Assistance Reduced +/- Confusion Total Bed Bound Unable to Do Any Work Total Care Reduced Full or Drowsy Extensive Disease +/- Confusion Total Bed Bound Unable to Do Any Work Total Care Minimal Full or Drowsy Extensive Disease Sips +/- Confusion Total Bed Bound Unable to Do Any Work Total Care Mouth Drowsy or Extensive Disease Care Only Coma Death x x x x

56 USES OF PPSV2 Communication Verbal Charting Service allocation Drug benefit Plan P Service monitoring eg. LOS Workload Home Care and weekend visits PPS 10%-30% need much physical care in bed PPS 40%-50% need assistance with walking; risk of falls PPS 60%-90% very little physical care Prognosis Care models Eg. Suandok Collaborative Care Cancer Care Ontario, Canada Psychosocial transition support Research demographic, prognostic, etc

57 PPS PITFALL IS A FUNCTIONAL PERFORMANCE SCALE NOT JUST PALLIATIVE We often get confused with word palliative in the PPSv2 scale It was designed mainly for patients with advanced progressive illness who are palliative Illnesses can be cancer, end stage heart, COPD, live failure, end stage renal failure, dementia, ALS, etc

58 PPS PITFALL IS A FUNCTIONAL PERFORMANCE SCALE NOT JUST PALLIATIVE But you also use it here in Chiang Mai for many medical and surgical wards who are not palliative and staff get confused For example, in Sub-ICU Medicine next slide Sometimes I think the name of PPS should be changed to Victoria Performance Scale or Suandok Performance Scale so it is easier to use in many patients But it is a functional assessment tool, so can be used for any illness, not just palliative For example, in Sub-ICU Medicine next slide

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