Entity Policy

Code: E-PC-4044

Entity: Fairview Red Wing Health Services Manual: Entity

Category: Provision of Care, Treatment and Services Subject: Provision of Palliative Care

Purpose: To provide a framework for initiation of palliative care planning and decision making for individuals and families affected by chronic disease and advanced illness.

Policy: Palliative care, by definition means to comfort and relieve suffering. Palliative care planning is an essential function of medicine and must be managed with sensitivity to the delicate issues confronting the patient and family. Palliative care is implemented by utilizing an interdisciplinary and holistic approach.

Procedure: 1. The role and responsibility of the palliative care team is to address the patient and family’s palliative care needs, and determine the best course of palliation, recommending it to the patient and family. 2. The palliative care team will work to aggressively search for ways to maximize the patient’s comfort and quality of life. 3. Care planning for the palliative care patient and family is an ongoing process. The role and authority of the palliative care team in care planning may vary according to the following possibilities: A. Philosophy, attitude, experience and education of the patient’s attending palliative care provider and team. B. The degree of trust the patient and family have with the palliative care team. C. The willingness and/or understanding of the patient and family to accept and comply with the palliative care team recommendations for care plan interventions 4. There may be several ways to palliate the same symptom. For example, pain could be addressed by any of the following (all could be considered palliative because their goal is comfort rather

K: Policies-Procedures/Entity Manual/PC/Provision of Palliative Care 4-1-08 Page 1 of 3 than cure): oral medications, intravenous medications, epidural route for medication administration, pain blocks, radiation therapy, and other higher level interventions including surgical intervention (at the direction of a physician). Pain symptoms may also be palliated through psychosocial and spiritual support. 5. In order for the palliative care team to recommend a given course of palliation, the following general guidelines should be followed: A. All other things being equal, the least invasive, least technological methods shall be the first choice B. Benefits versus burdens of the treatment should be included C. Recommendations should be made with the patient’s goals and philosophy in mind. Recognizing and honoring patient choice is a fundamental tenet of palliative care. It is of greatest need to have the patient / family fully appraised of the implications of their treatment choices.

Process of 1. Provider will recommend to patient/family the option for a Palliative Palliative Care Care referral following the evaluation of their health status and long Referral: term care needs. Any health care professional, family, friend or individual recognizes that an individual with chronic and/or advanced illness is appropriate for palliative care and initiates a palliative care referral. A written order (CONSULT TO OTHER SPECIALTY: specifying palliative care) will need to be documented in patient’s chart. Nursing or Social Services to contact Specialty Medical Services upon obtaining verbal or written order for palliative care consult. 2. Initial contact by Palliative Care Nurse Practitioner or another health care provider working with the patient will be made as soon as possible in light of resources after receiving notification of a verbal or written palliative care consult order. 3. Palliative Care Assessment to be initiated and conducted based on the assessment of initial contact. It is during the palliative care assessment that the provider and/or other palliative care team member asks the patient for presence of an advance health care directive. Ask patient to identify a representative/surrogate decision maker. Provider or team member to document representative’s contact information on the plan of care. 4. Palliative care team documents patient goals and desires on the plan of care. Communicates patient goals and desires to all individuals involved in patient’s plan of care. 5. Implement palliative care orders. Regardless, treat symptoms aggressively to relieve patient’s discomfort as much as possible. Vital signs should not influence decisions about administering

K: Policies-Procedures/Entity Manual/PC/Provision of Palliative Care 4-1-08 Page 2 of 3 medications for management of symptoms at the end of life. Document indications for medication including dose changes in the medical record. 6. Educate patient/family regarding symptom management, what to expect during this phase of life and available options. 7. Palliative care team assesses patient for worsening and end of life symptoms on a routine basis. Incorporate patient’s acceptable levels of symptoms relief with desired level of consciousness or the ability or carry out other activities. 8. Assess emotional and spiritual suffering. Provide support and involve resources such as cultural and spiritual health care as appropriate. Contact spiritual and social services as necessary. 9. Make appropriate referrals to include all needed team members: palliative care nurse practitioner, palliative care physician champion, primary provider, chaplain, social worker, pharmacy, respiratory therapy, physical therapy, occupational therapy, dietician, homecare, hospice, and other disciplines as needed 10. Modify care and practice routines to meet the comfort needs of the patient and to support family interaction 11. Assess discharge needs and assist patient and family with arrangements (as able) to facilitate that death will occur in the setting of their choice.

Internal Ref:

Source: Provider Staff

Approved By: MPC

Date Effective: 10/00

Date Revised: 12/07, 02/08, 04/08

Date Reviewed:

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