Clinical Practice Guidelines for Quality Palliative Care

Transcription

Clinical
Pracce
Guidelines
for Quality
Palliave
Care
THIRD EDITION
FOR QUA LIT Y PALLIAT I V E CARE
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P?
DOMAIN 2.
PHYSICAL ASPECTS
OF CARE
PREFERRED PRACTICE 12
"
Measure and document pain, dyspnea, constipation, and other symptoms using available
standardized scales.
"
DOMAIN 3.
PSYCHOLOGICAL AND
PSYCHIATRIC
ASPECTS OF CARE
Assess and manage symptoms and side effects in a timely, safe, and effective manner to a level
acceptable to the patient and family.
"
Measure and document anxiety, depression, delirium, behavioral disturbances, and other
common psychological symptoms using available standardized scales.
"
Manage anxiety, depression, delirium, behavioral disturbances, and other common
psychological symptoms in a timely, safe, and effective manner to a level acceptable to the
patient and family
"
Assess and manage psychological reactions of patients and families to address emotional and
functional impairment and loss, (including stress, anticipatory grief and coping), in a regular
ongoing fashion.
"
DOMAIN 4.
SOCIAL ASPECTS OF
CARE
Develop and offer a grief and bereavement care plan to provide services to patients and families
prior to and for at least 13 months after the death of the patient.
"
Conduct regular patient and family care conferences with physicians and other appropriate
members of the interdisciplinary team to provide information, discuss goals of care, disease
prognosis, and advanced care planning, and offer support.
"
DOMAIN 5.
SPIRITUAL,
RELIGIOUS, AND
EXISTENTIAL
ASPECTS OF CARE
Develop and implement a comprehensive social care plan which addresses the social, practical
and legal needs of the patient and caregivers, including but not limited to: relationships,
communication, existing social and cultural networks, decisionmaking, work and school settings,
finances, sexuality/intimacy, caregiver availability/stress, and access to medicines and
equipment.
"
Develop and document a plan based on assessment of religious, spiritual, and existential
concerns using a structured instrument and integrate the information obtained from the
assessment into the palliative care plan.
"
Provide information about the availability of spiritual care services and make spiritual care
available either through organizational spiritual counseling or through the patient’s own clergy
relationships.
"
Specialized palliative and hospice care teams should include spiritual care professionals
appropriately trained and certified in palliative care.
PO
Specialized palliative and hospice spiritual care professionals should build partnerships with
community clergy, and provide education and counseling related to end-of-life care.
"
DOMAIN 6.
CULTURAL ASPECTS
OF CARE
"
Incorporate cultural assessment as a component of comprehensive palliative and hospice care
assessment, including, but not limited to: locus of decisionmaking, preferences regarding
disclosure of information, truth telling and decisionmaking, dietary preferences, language, family
communication, desire for support measures such as palliative therapies and complementary
and alternative medicine, perspectives on death, suffering and grieving, and funeral/burial rituals.
"
DOMAIN 7.
CARE OF PATIENT AT
END OF LIFE
Provide professional interpreter services and culturally sensitive materials in the patient’s and
family’s preferred language.
"
Recognize and document the transition to the active dying phase and communicate to the
patient, family, and staff the expectation of imminent death.
"
The family is educated on a timely basis regarding signs and symptoms of imminent death in a
developmentally, age-, and culturally appropriate manner.
"
As part of the ongoing care planning process, routinely ascertain and document patient and
family wishes about the care setting for site of death, and fulfill patient and family preferences
when possible.
"
Provide adequate dosage of analgesics and sedatives as appropriate to achieve patient comfort
during the active dying phase and address concerns and fears about using narcotics and of
analgesics hastening death.
"
Treat the body post-death with respect according to the cultural and religious practices of the
family and in accordance with local law.
"
DOMAIN 8.
ETHICAL AND LEGAL
ASPECTS OF CARE
Facilitate effective grieving by implementing in a timely manner a bereavement care plan after
the patient’s death when the family remains the focus of care.
"
Document the designated surrogate/decisionmaker in accordance with state law for every
patient in primary, acute, and long-term care and in palliative and hospice care.
"
Document the patient/surrogate preferences for goals of care, treatment options, and setting of
care at first assessment and at frequent intervals as conditions change.
"
Convert the patient treatment goals into medical orders and ensure that the information is
transferable and applicable across care settings, including long-term care, emergency medical
services, and hospitals, such as the Physician Orders for Life-Sustaining Treatments (POLST)
Program.
"
Make advance directives and surrogacy designations available across care settings, while
PQ
protecting patient privacy and adherence to Health Insurance Portability and Accountability Act
(HIPAA) regulations, e.g., by Internet-based registries or electronic personal health records.
"
Develop healthcare and community collaborations to promote advance care planning and
completion of advance directives for all individuals, e.g., Respecting Choices, Community
Conversations on Compassionate Care.
"
Establish or have access to ethics committees or ethics consultation across care settings to
address ethical conflicts at the end of life.
"
For minors with decisionmaking capacity, document the child’s views and preferences for
medical care, including assent for treatment, and give appropriate weight in decisionmaking.
Make appropriate professional staff members available to both the child and the adult
decisionmaker for consultation and intervention when the child’s wishes differ from those of the
adult decisionmaker.
Adapted from The National Consensus Project for Palliative Care 2013 Clinical Practice Guidelines for Palliative Care and the National
Quality Forum 2006 A National Framework and Preferred Practices for Palliative and Hospice Care Quality: A Consensus Report.
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For more copies of this publication, please contact:
National Consensus Project
One Penn Center West, Suite 229
Pittsburgh, PA 15276-0100
Phone: 412.787.9301
Fax: 412.787.9305
[email protected]
© Copyright 2009, National Consensus Project for Quality Palliative Care
ISBN 978-1-934654-35-4
9 781934 654354

Clinical Practice Guidelines for Quality Palliative Care

Transcription

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