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P132 Paramedics Providing Palliative Care at Home in Nova Scotia and PEI, Canada
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Selected Abstracts
Advance Directive (AD), and communicating choices among family, care providers, and others. At our cancer center, processes were in place to facilitate ACP. However, the AD completion rate was thirty-two percent, indicating the need for greater clinician and patient engagement. An interdisciplinary ACP Implementation Task Force was established to lead organizationwide change. Opportunities were identified to incorporate ACP throughout the oncology care continuum and to promote patient’s understanding and engagement. Solutions were proposed that focused on changing clinical processes and leveraging technology to foster ACP. The following describes the technology-related solutions. An electronic interdisciplinary plan of care (IPOC) was developed with specific ACP goals, interventions, and outcomes. Electronic triggers were built to initiate this IPOC when a patient does not have an AD in the chart. The IPOC provides valuable information and guidance to clinicians in the ACP process. Design sessions are currently underway to incorporate ACP into the interactive patient care system. Instructional videos on ACP are available on demand and will be assigned for patient viewing when a patient does not have an AD. Once a video is watched, a comprehension question will be asked and generate a referral for follow-up. Results reveal an increase in the AD completion rate to 39%. Data suggests that technological enhancements to ACP can improve AD completion. Upon full implementation in June 2016 of the interactive patient care system for ACP, we will assess if it led to increased patient engagement and higher AD completion rates. Other technological enhancements, such as ACP documentation templates, will also be considered.
Interprofessional Teamwork P132 Paramedics Providing Palliative Care at Home in Nova Scotia and PEI, Canada
Marianne Arab1, Alix Carter2,3, Michelle Harrison1 1 Cancer Care Nova Scotia/Nova Scotia Heatlh Authority, Halifax, NS, Canada 2 Nova Scotia Emergency Health Services, NS, Canada 3 Dalhousie University, Dept Emergency Medicine, Division of EMS, Halifax, NS, Canada Background: Paramedics are often seen as providers of life-saving interventions and palliative care focuses on comfort and symptom relief when faced with a life limiting illness. Although the two worlds may not appear to have much in common, paramedics are often called to symptom crises in palliative care
Vol. 52 No. 6 December 2016
patients, and this would typically have resulted in a trip to the hospital. Many Canadians wish to spend their dying days at home, but home deaths constitute less than a quarter of deaths. Method: Nova Scotia and PEI have launched the ‘Paramedics Providing Palliative Care at Home Program’ to enhance the care provided by paramedics for palliative care patients. The program includes an innovative palliative clinical practice guideline, paramedic palliative education package, and a database which provides the opportunity for comfort care or selective treatment instead of a resuscitation-focused encounter. Paramedics can now provide relief of common symptoms such as nausea, breathlessness, pain and agitation, without transport to the hospital. Results: Around 400 palliative patients have been registered in the enhanced database to date. Health care providers have reported qualitatively that the 24/7 support of paramedics for palliative care crisis serves as a safety net for patients in the community and increases their confidence in choosing to remain home. Conclusion: This program has demonstrated that palliative support can be effectively integrated into paramedic practice and result in acute palliative crises being managed at home.
P134 When Palliative Care Takes Over - Do We Make a Difference? A PostBereavement Survey of Family Members Mervyn Koh, Ang Ching Ching, Zheng Jiamin, Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore Background and Hypothesis: Palliative Care Units and palliative care primary teams have been shown to improve patient and family satisfaction. Our unit had started a 13 bed palliative care unit in 2014 and we wanted to study whether the intervention of a palliative care primary team improved family satisfaction in the domains of symptom control, communication and managing emotional needs. Methods: We surveyed bereaved family members of 180 patients who had passed on in our hospital from Jan-Dec 2014. They were distributed into 3 groups e 60 (no palliative care), 60 had a palliative care consultation, 60 under Palliative Care Primary Team. The survey questionnaire included demographics, satisfaction with symptom control, information sharing and involvement in decision-making, emotional and spiritual needs and whether they would recommend the palliative care team to others. They
Selected Abstracts
Advance Directive (AD), and communicating choices among family, care providers, and others. At our cancer center, processes were in place to facilitate ACP. However, the AD completion rate was thirty-two percent, indicating the need for greater clinician and patient engagement. An interdisciplinary ACP Implementation Task Force was established to lead organizationwide change. Opportunities were identified to incorporate ACP throughout the oncology care continuum and to promote patient’s understanding and engagement. Solutions were proposed that focused on changing clinical processes and leveraging technology to foster ACP. The following describes the technology-related solutions. An electronic interdisciplinary plan of care (IPOC) was developed with specific ACP goals, interventions, and outcomes. Electronic triggers were built to initiate this IPOC when a patient does not have an AD in the chart. The IPOC provides valuable information and guidance to clinicians in the ACP process. Design sessions are currently underway to incorporate ACP into the interactive patient care system. Instructional videos on ACP are available on demand and will be assigned for patient viewing when a patient does not have an AD. Once a video is watched, a comprehension question will be asked and generate a referral for follow-up. Results reveal an increase in the AD completion rate to 39%. Data suggests that technological enhancements to ACP can improve AD completion. Upon full implementation in June 2016 of the interactive patient care system for ACP, we will assess if it led to increased patient engagement and higher AD completion rates. Other technological enhancements, such as ACP documentation templates, will also be considered.
Interprofessional Teamwork P132 Paramedics Providing Palliative Care at Home in Nova Scotia and PEI, Canada
Marianne Arab1, Alix Carter2,3, Michelle Harrison1 1 Cancer Care Nova Scotia/Nova Scotia Heatlh Authority, Halifax, NS, Canada 2 Nova Scotia Emergency Health Services, NS, Canada 3 Dalhousie University, Dept Emergency Medicine, Division of EMS, Halifax, NS, Canada Background: Paramedics are often seen as providers of life-saving interventions and palliative care focuses on comfort and symptom relief when faced with a life limiting illness. Although the two worlds may not appear to have much in common, paramedics are often called to symptom crises in palliative care
Vol. 52 No. 6 December 2016
patients, and this would typically have resulted in a trip to the hospital. Many Canadians wish to spend their dying days at home, but home deaths constitute less than a quarter of deaths. Method: Nova Scotia and PEI have launched the ‘Paramedics Providing Palliative Care at Home Program’ to enhance the care provided by paramedics for palliative care patients. The program includes an innovative palliative clinical practice guideline, paramedic palliative education package, and a database which provides the opportunity for comfort care or selective treatment instead of a resuscitation-focused encounter. Paramedics can now provide relief of common symptoms such as nausea, breathlessness, pain and agitation, without transport to the hospital. Results: Around 400 palliative patients have been registered in the enhanced database to date. Health care providers have reported qualitatively that the 24/7 support of paramedics for palliative care crisis serves as a safety net for patients in the community and increases their confidence in choosing to remain home. Conclusion: This program has demonstrated that palliative support can be effectively integrated into paramedic practice and result in acute palliative crises being managed at home.
P134 When Palliative Care Takes Over - Do We Make a Difference? A PostBereavement Survey of Family Members Mervyn Koh, Ang Ching Ching, Zheng Jiamin, Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore Background and Hypothesis: Palliative Care Units and palliative care primary teams have been shown to improve patient and family satisfaction. Our unit had started a 13 bed palliative care unit in 2014 and we wanted to study whether the intervention of a palliative care primary team improved family satisfaction in the domains of symptom control, communication and managing emotional needs. Methods: We surveyed bereaved family members of 180 patients who had passed on in our hospital from Jan-Dec 2014. They were distributed into 3 groups e 60 (no palliative care), 60 had a palliative care consultation, 60 under Palliative Care Primary Team. The survey questionnaire included demographics, satisfaction with symptom control, information sharing and involvement in decision-making, emotional and spiritual needs and whether they would recommend the palliative care team to others. They