Symptom Relief Kit: Innovative Symptom Control in Palliative Care Suzanne d Entremont RN, BScN District Executive Director, VON Tri-County, NS Chief of Practic, VON Canada, Eastern Canada
The Issue The notion of a SRK (Symptom Relief Kit) was developed subsequent to the need identified by frontline nurses providing palliative care Client takes a quick, unexpected turn, condition deteriorates rapidly Med management for acute episodes and treatment had not been determined yet WWW.VON.CA 2
The Issue Nurse not able to reach/contact physician to get meds/orders to relieve acute symptoms of the dying client Client destined to either die an agonizing death at home, with support folks/family agonizing as well, or chose to be transported to hospital to end life on a stretcher in ER, not at home surrounded by loved ones at home as was their wish WWW.VON.CA 3
SRK Committee formulation Discussions with district palliative care physician and district palliative and supportive care team Multi-disciplinary committee formed comprised of: Dr. Leahey, Palliative Care Physician Thelma Newell, RN, VON Nurse Ellen Pothier, RN, VON Nurse Sheila d Eon, District Palliative Nurse Nancy Castlebury, Supportive Care Manager Denise Roman, Long Term Care Bruce Johnson, Pharmacist, local pharmacy WWW.VON.CA 4
Goal of SRK committee Work together in partnership to develop a SRK to reduce the time delay in control of symptoms experienced by palliative clients in their home by having selected medications readily available for palliative emergencies WWW.VON.CA 5
Symptom Relief Kit The kit has been designed to provide 24-48 hour supply of commonly used medications in end-oflife care at home for crisis managment The kit is only to be used for emergency situations, however it s use has been modified Meds contained may be given by nurse on a PRN basis as indicated by physician following doctor s order sheet WWW.VON.CA 6
Guided by VON Mission Leadership in community based care, demonstrating the core values of VON Respec to the needs of the dying client and family Participation of the client and family, nurse and physician in decisions made to affect care Responsiveness to an identified need Courage to take the challenge and make a difference Hope for a good death WWW.VON.CA 7
SRK and VON Care and Service Model Core of Care and Service Model is person, family and social network, community and society The process has encompassed the core utilizing practice, policy and the research to promote the desired outcomes Process has an evaluation component, which includes the family/support network of the client as well as other health care providers involved in care WWW.VON.CA 8
Process. December 2006 committee is formed We know what is needed how do we make it available to nurses 24/7? Partnership with 8 long term care facilities to house SRKs (in three counties covering a large geographical area) Process developed Education to district team members, ie. Physicians, nurses, LTC Pharmacy to develop, maintain and refill kits WWW.VON.CA 9
We need money.. Provincial government DOH has medication coverage in 10 year plan, however, not able to provide financial support at this time District Health Authority approached and supports initiative with $5000 for first year and $10,000 for second year WWW.VON.CA 10
First kit in place October 2007 Nurse determines need for SRK use Call or fax physician to request SRK Ensure MD signs Expected Death at home and DNR forms Receipt of order sheet from physician VON nurse infomrs LTC of name of family member (or advocate) who will be picking up kit VON nurse signs release form for SRK for family member to bring to LTC Sign out sheet is kept at the LTC facility WWW.VON.CA 11
Testament Kits have been utilized at least 140 times since October 2007 SRK has been transformational in providing best care to our patients with terminal illnesses who chose to spend the end of their life at home. Dr. Leahey medical colleagues have benefited from this program as well. They have enhanced their knowledge of best options for palliative symptom relief and become more familiar (and appreciative) of VON services Dr. Leahey WWW.VON.CA 12
Accreditation Canada The SRK was developed and implemented across the continuum of care with input from doctors, nurses, specialists, the Victorian Order of Nurses, Continuing Care and patients. It is stored in the nursing home venues and accessible 24 hours per day. The availability of these kits has dramatically reduced the need for admission for sudden pain control of the palliative care population. It is a great success story Accreditation Canada, South West Nova District Health Authority, October, 2008 WWW.VON.CA 13
Testament. nurses utilizing the kit have found it to be comprehensive, accessible, responsive and realistic. It has helped to clarify the necessary processes required to effectively care for clients who wish to die at home the accessibility of the kit, availability of necessary meds and practicality of its implementation has enhanced the quality of life for palliative clients and their families experience of death in the home Margaret O Neil, RN, BScN, NP, staff nurse, VON WWW.VON.CA 14