DOCSLIB.ORG

Clinical Practice Guidelines for Quality Palliative Care

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Clinical Practice Guidelines for Quality Palliative Care Clinical Practice Guidelines for Quality Palliative Care 4th edition Publisher: National Coalition for Hospice and Palliative Care Clinical Practice Guidelines for Quality Palliative Care, 4th edition Copyright 2018 National Coalition for Hospice and Palliative Care This publication is copyrighted. We are making such material available in our efforts to advance understanding of issues related to hospice and palliative care. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, electronic, photocopying, recording or otherwise, without prior written permission of the publisher. Disclaimer: The National Coalition for Hospice and Palliative Care assumes no responsibility or liability for any errors or omissions in the National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care, 4th edition. The information contained is provided on an “as is” basis with no guarantees of completeness, accuracy, usefulness or timeliness and without any warranties of any kind whatsoever, express or implied. The information is intended for non-commercial use for the user who accepts full responsibility for its use. While the National Coalition for Hospice and Palliative Care has taken every precaution to ensure that the content is current and accurate, errors can occur. Adherence to these guidelines will not ensure successful treatment in every situation. Furthermore, these guidelines should not be interpreted as setting a standard of care, considered to be medical advice, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and/or health care provider and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the disease. These guidelines reflect the best available data and information at the time the guidelines were prepared. The results of future studies may require revisions to the recommendations in these guidelines to reflect new data or information. ISBN # 978-0-692-17943-7 For information, contact: National Coalition for Hospice and Palliative Care P.O. Box 29709 Richmond, VA 23242 http://www.nationalcoalitionhpc.org/ https://www.nationalcoalitionhpc.org/ncp Suggested Citation: National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care, 4th edition. Richmond, VA: National Coalition for Hospice and Palliative Care; 2018. https://www. nationalcoalitionhpc.org/ncp. Table of Contents Foreword i Palliative Care . i History of the National Consensus Project’s Guidelines . iii . NCP Guidelines, 4th edition . v Introduction to the 4th edition vii Summary of Key Revisions in Each Domain . viii . Systematic Review of Key Research Evidence . ix . Key Concepts / Definitions . ix. Using the NCP Guidelines . x . Conclusion xi Acknowledgments xii Domain 1: Structure and Processes of Care 1 Guideline 1 .1 Interdisciplinary Team . 1. Guideline 1 .2 Comprehensive Palliative Care Assessment . 2 Guideline 1 .3 Palliative Care Plan . 3. Guideline 1 .4 Continuity of Palliative Care . 5 Guideline 1 .5 Care Settings . 5. Guideline 1 .6 Interdisciplinary Team Education . 6. Guideline 1 .7 Coordination of Care and Care Transitions . .7 . Guideline 1 .8 Emotional Support to the Interdisciplinary Team . 7 . Guideline 1 .9 Continuous Quality Improvement . 7 Guideline 1 .10 Stability, Sustainability, and Growth . 8 Clinical and Operational Implications . 8 Essential Palliative Care Skills Needed by All Clinicians . 9. Key Research Evidence . .9 . Practice Examples . 9 Domain 2: Physical Aspects of Care 13 Guideline 2 .1 Global . .13 . Guideline 2 .2 Screening and Assessment . .14 . Guideline 2 .3 Treatment . 14 . Guideline 2 .4 Ongoing Care . 15 Clinical and Operational Implications . 16 Essential Palliative Care Skills Needed by All Clinicians . 16 . Key Research Evidence . 16. Practice Examples . 17 Table of Contents Domain 3: Psychological and Psychiatric Aspects of Care 20 Guideline 3 .1 Global . .20 . Guideline 3 .2 Screening and Assessment . 21 . Guideline 3 .3 Treatment . 22. Guideline 3 .4 Ongoing Care . 23. Clinical and Operational Implications . 23 Essential Palliative Care Skills Needed by All Clinicians . 23 . Key Research Evidence . 24. Practice Examples . 24 Domain 4: Social Aspects of Care 26 Guideline 4 .1 Global . .26 . Guideline 4 .2 Screening and Assessment . .27 . Guideline 4 .3 Treatment . 28 . Guideline 4 .4 Ongoing Care . 28 Clinical and Operational Implications . 29 Essential Palliative Care Skills Needed by All Clinicians . 29 . Key Research Evidence . 29. Practice Examples . 30 Domain 5: Spiritual, Religious, and Existential Aspects of Care 32 Guideline 5 .1 Global . .32 . Guideline 5 .2 Screening and Assessment . 33 . Guideline 5 .3 Treatment . 34. Guideline 5 .4 Ongoing Care . 34 Clinical and Operational Implications . 35 Essential Palliative Care Skills Needed by All Clinicians . 35 . Key Research Evidence . 35. Practice Examples . 35 Domain 6: Cultural Aspects of Care 38 Guideline 6 .1 Global . 38 Guideline 6 .2 Communication and Language . 39 . Guideline 6 .3 Screening and Assessment . .40 . Guideline 6 .4 Treatment . 41 . Clinical and Operational Implications . 42 Essential Palliative Care Skills Needed by All Clinicians . 42 . Key Research Evidence . 42. Practice Examples . 43 Table of Contents Domain 7: Care of the Patient Nearing the End of Life 45 Guideline 7 .1 Interdisciplinary Team . 45 . Guideline 7 .2 Screening and Assessment . .46 . Guideline 7 .3 Treatment Prior to Death . 47. Guideline 7 .4 Treatment During the Dying Process and Immediately After Death . 47 . Guideline 7 .5 Bereavement . 48 Clinical and Operational Implications . 49 Essential Palliative Care Skills Needed by All Clinicians . 49 . Key Research Evidence . 50. Practice Examples . 50 Domain 8: Ethical and Legal Aspects of Care 52 Guideline 8 .1 Global . .52 . Guideline 8 .2 Legal Considerations . 53. Guideline 8 .3 Screening and Assessment . .55 . Guideline 8 .4 Treatment and Ongoing Decision-Making . 56 . Clinical and Operational Implications . 57 Essential Palliative Care Skills Needed by All Clinicians . 57 . Key Research Evidence . 57. Practice Examples . 57 Appendix I: Glossary 60 Appendix II: Tools and Resources 70 Domain 1: Structure and Processes of Care . 70. Domain 2: Physical Aspects of Care . .71 . Domain 3: Psychological and Psychiatric Aspects of Care . 74. Domain 4: Social Aspects of Care . 75. Domain 5: Spiritual, Religious, and Existential Aspects of Care . .76 . Domain 6: Cultural Aspects of Care . .77 . Domain 7: Care of the Patient Nearing the End of Life . .78 . Domain 8: Ethical and Legal Aspects of Care . .79 . Appendix III: Contributors 85 Table of Contents Appendix IV: Scoping Review 87 Scoping Review Methodology . 87. Review and Inclusion Process . 90 Domain 1: Structure and Processes of Care . 90. Domain 2: Physical Aspects of Care . 113. Domain 3: Psychological and Psychiatric Aspects of Care . 126 . Domain 4: Social Aspects of Care . 132 . Domain 5: Spiritual, Religious, and Existential Aspects of Care . 136. Domain 6: Cultural Aspects of Care . 142. Domain 7: Care of the Patient Nearing the End of Life . 152. Domain 8: Ethical and Legal Aspects of Care . 158. Appendix V: Endorsing and Supporting Organizations 165 A systematic review of the evidence for the NCP Guidelines, 4th edition, was conducted by the RAND Evidence-based Practice Center. The complete findings are published online in the Journal of Pain and Symptom Management (doi: 10.1016/j.jpainsymman.2018.09.008). Foreword Individuals who are seriously ill need care that is seamless across settings, can rapidly respond to needs and changes in health In this document, serious status, and is aligned with patient-family preferences and goals . illness is defined as “a health Patients of all ages, living in all areas of the country, have unmet condition that carries a high care needs that cause a burden on families and the US health care risk of mortality and either system . negatively impacts a person’s daily function or quality of Providing “crisis-care” to individuals with a serious illness whose life or excessively strains their ongoing care needs are poorly managed has resulted in increased caregiver” (Kelley and Bollens- health care spending that does not necessarily improve quality of Lund, 2018). life . Care of individuals with serious illness is often “marked by inadequate symptom control and low patient and family perceptions of the quality of care; and potentially discordant with personal goals and preferences .”1 Patients with serious illness and their family caregivers are seldom able to have their care needs reliably met, leading to symptom exacerbation crises and emergency department visits and/or repeated hospitalizations .2 Palliative Care Palliative care focuses on expert assessment and management of pain and other symptoms, assessment and support of caregiver needs, and coordination of care . Palliative care attends to the physical, functional, psychological, practical, and spiritual consequences of a serious illness . It is a person- and family-centered approach to care, providing people living with serious illness relief from the symptoms and stress of an illness . Through early integration into the care plan for the seriously ill, palliative
Load more

Recommended publications
  • The Changing Nature of Palliative Care: Implications for Allied Health Professionals’ Educational and Training Needs
    healthcare Article The Changing Nature of Palliative Care: Implications for Allied Health Professionals’ Educational and Training Needs Deidre D. Morgan 1,* , Deb Rawlings 1,2 , Carly J. Moores 3, Lizzie Button 2 and Jennifer J. Tieman 1,2 1 Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide 5001, Australia; deborah.rawlings@flinders.edu.au (D.R.); jennifer.tieman@flinders.edu.au (J.J.T.) 2 CareSearch, Flinders University, Adelaide 5001, Australia; elizabeth.button@flinders.edu.au 3 Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide 5001, Australia; carly.moores@flinders.edu.au * Correspondence: deidre.morgan@flinders.edu.au; Tel: +61-8-7221-8220 Received: 11 August 2019; Accepted: 26 September 2019; Published: 28 September 2019 Abstract: CareSearch is an Australian Government Department of Health funded repository of evidence-based palliative care information and resources. The CareSearch Allied Health Hub was developed in 2013 to support all allied health professionals working with palliative care clients in all clinical settings. This cross-sectional online survey sought to elicit allied health professionals palliative care experiences and subsequent considerations for educational and clinical practice needs. The survey was disseminated nationally via a range of organisations. Data was collected about palliative care knowledge, experience working with palliative care clients and professional development needs. Data were evaluated by profession, experience and practice setting. In total, 217 respondents answered one or more survey questions (94%). Respondents (65%) reported seeing >15 palliative care clients per month with 84% seen in hospital and community settings. Undergraduate education underprepared or partially prepared allied health professionals to work with these clients (96%) and 67% identified the need for further education.
    [Show full text]
  • Hospice and Assisted Living: Improving Care at the End of Life
    Hospice and Assisted Living: Improving Care at the End of Life Cherry Meier, RN, MSN eniors have embraced the concept of “aging in place.” S The challenge that inevitably occurs is the concept of “dying in place.” Seniors do not want to go through another change in living arrangements and do not want to become a burden on their families at the end of their life. Is it realistic to think that an eld- erly resident may be able to die in an assisted living (AL) residence? Depending upon what state you live in, it may or may not be possi- ble. Some states have very strict move-in and discharge require- ments that prohibit a dying resident from staying in their AL residence because they become bedbound, have a foley catheter, or require oxygen. Such requirements are usu- ally in response to concerns for life and safety in the event that a build- ing needs to be evacuated quickly or that the resident has complex 6 months or less if the illness runs equipment, and medical supplies needs that cannot be met by the AL its normal course and elects to re- related to the terminal illness. staff. Other states waive these rules ceive palliative/comfort care instead • On-call services, 24 hours a day. for residents who elect to receive of curative care. The AL residence • Bereavement care to the family/ care from hospice. is considered to be the resident’s loved ones following the death home, where the following services of the resident. The Medicare Hospice Benefit can be provided: The Medicare Hospice Benefit is • Services by an interdisciplinary The goal of care is to control the available to Medicare and Medicaid health care team comprised of resident’s pain and other uncomfort- beneficiaries in all states, except physicians, nurses, home health able symptoms through the dying Oklahoma, New Hampshire, and aides, social workers, chaplains, process.
    [Show full text]
  • Value-Driven Health Care Purchasing: Four States That Are Ahead of the Curve
    VALUE-DRIVEN HEALTH CARE PURCHASING: FOUR STATES THAT ARE AHEAD OF THE CURVE OVERVIEW Sharon Silow-Carroll and Tanya Alteras Health Management Associates August 2007 ABSTRACT: Health care purchasers, suppliers, and consumers are rallying for better-quality health care. In response, several states are pursuing value-based purchasing (VBP) initiatives that emphasize collection of quality-of-care data, transparency of quality and cost information, and incentives. In this overview of public–private VBP efforts in Massachusetts, Minnesota, Washington, and Wisconsin, the authors find that tiered premiums, pay-for-performance measures, and the designation of high-performance providers as “centers of excellence” are paying off. Minnesota, for example, has used incentives to achieve about $20 million in savings in 2006. Similarly, Wisconsin’s Department of Employee Trust Funds has announced premium rate increases in the single digits for the third straight year. More research is necessary to determine the true impact of VBP, but health plans and providers are paying attention to and learning from these current efforts. (Note: Accompanying the overview report are four separate state case studies, available at http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=515778.) Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. This report and other Fund publications are available online at www.commonwealthfund.org. To learn more about new publications when they become available, visit the Fund’s Web site and register to receive e-mail alerts. Commonwealth Fund pub.
    [Show full text]
  • Botswana Health Professions Council (BHPC) Before Seeing Patients
    BHPC Application Instructions for BUP Travelers Just as no person would be allowed to walk onto the wards of HUP or any other US hospital and begin treating patients without presenting their credentials, no one may practice in any hospital or clinic in Botswana without official permission. Any physician practicing medicine in Botswana is required to register with the Botswana Health Professions Council (BHPC) before seeing patients. To register you must bring the following documents with you to Botswana: 4 x passport photos 1 x notarized copy of passport photo page 2 x letters of recommendation from doctors/supervisors you work with (letters to be original, no digital copies allowed by BHPC, dated no older than six months) 1 x notarized copy of your medical degree/diploma 1 x notarized copy of your state medical license/registration 1 x CV Copy of offer letter (provided in Botswana) Cover letter of application form (provided in Botswana) Application fee (P30 ≈ $3) BUP staff will assist you in completing the application (pp 3-6 of this document) in country and take you to the BHPC on your first day during orientation to submit the forms and then again on the Wednesday following arrival to receive your approval. Note that you cannot practice medicine until the BHPC registration is completed. You should plan to arrive in Botswana on the weekend prior to when you plan to work so that your BHPC application can be turned in on Monday and you can receive registration certification on Wednesday afternoon. You will then be able to start to practice medicine on Thursday.
    [Show full text]
  • Quality Health Care
    . Quality Health Care • Centers of Excellence • Improving Quality Quality Health Care Quality • Pay for Performance • Literature Centers of Excellence The term “Center of Excellence” has been widely used and in many different ways. The basic concept behind health care centers of excellence is that a provider who specializes in a particular type of program or service can produce better outcomes. One example of a center of excellence program is the National Cancer Institute's (NCI) cancer center program that was created in 1971 to establish regional centers of excellence in cancer research and patient care. The NCI cancer center designation is an official designation. Providers must meet certain criteria and demonstrate excellence in research, cancer prevention and clinical services. NCI designation helps institutions compete for both research dollars and patients. The term “Center of Excellence” has also been used by many without official designation. Some providers of care simply proclaim themselves centers of excellence. This is especially true for specialty hospitals that have been proliferated in many parts of the country. While these facilities may specialize in a particular service, there may not be clinical evidence demonstrating that the care they provide is superior. Similarly, insurers may include "Centers of Excellence" in their networks, but the extent to which these facilities have met established performance benchmarks is not always clear. While some insurers go to great length to identify the highest quality providers for certain services, others may establish a "Center of Excellence" primarily to concentrate volume to achieve more favorable payment rates. Much of the literature on Centers of Excellence has focuses on the relationship between volume and outcomes.
    [Show full text]
  • Self-Care for the Hospice Professional by Sally Hill Jones, Phd, LCSW
    A Delicate Balance: Self-Care For the Hospice Professional By Sally Hill Jones, PhD, LCSW Cindy, an experienced hospice professional, approached me one Monday morning, saying, “I think I’m losing it. Just the thought of seeing my patients today is too much.” She then described taking repeated showers but feeling that she still had the “smell of death” on her afterward. There had been an unusual number of deaths during her weekend on call, and as she named her patients, she began to cry. We devised a plan to begin her emotional processing that included taking the day off, journaling, talking to others she trusts, and saying good-bye to her patients. Service to individuals at the end of life and their families is an experience rich with meaning. Some important tasks can be accomplished only at life’s end, providing the opportunity for life review, healing, and coming to terms with one’s legacy. It is a time of potentially profound emotions and spiritual connections, letting go of the physical self and embracing the intangible inheritance left behind. To be involved professionally at this crucial time is deeply rewarding and yet demanding. Hospice staff regularly experience a wide range of powerful emotions, the mystical space between the physical and spiritual worlds, and the reality of loss and death. End-of-life experiences range from inspiring, graceful processes to difficult, complex situations with layers of long-standing problems, few resources, and the potential for abuse or suicide. Given the scope and intensity of hospice work, thoughtful, intentional focus on self-care is necessary for hospice professionals to remain effective.
    [Show full text]
  • New Zealand Palliative Care Glossary
    New Zealand Palliative Care Glossary Released 2015 health.govt.nz Citation: Ministry of Health. 2015. New Zealand Palliative Care Glossary. Wellington: Ministry of Health. Published in December 2015 by the Ministry of Health PO Box 5013, Wellington 6145, New Zealand ISBN 978-0-947491-36-9 (online) HP 6308 This document is available at health.govt.nz This work is licensed under the Creative Commons Attribution 4.0 International licence. In essence, you are free to: share ie, copy and redistribute the material in any medium or format; adapt ie, remix, transform and build upon the material. You must give appropriate credit, provide a link to the licence and indicate if changes were made. Palliative Care Council of New Zealand The Palliative Care Council was established in 2008 by Cancer Control New Zealand to provide independent and expert advice to the Minister of Health and to report on New Zealand’s performance in providing palliative and end of life care. Cancer Control New Zealand and the Palliative Care Council was disestablished on 8 August 2015 by the Minister of Health. The Palliative Care Council included representatives from the New Zealand Branch of the Australian and New Zealand Society of Palliative Medicine, Hospice New Zealand, Hospital Palliative Care New Zealand and Palliative Care Nurses New Zealand, and members nominated by the Royal NZ College of GPs/NZ Rural GP network, Nursing Council of NZ, Māori and consumers. The New Zealand Palliative Care Glossary is now the responsibility of the Ministry of Health. PO Box 5013
    [Show full text]
  • The Power of TRU COMPLIANCETM
    The Power of TRU COMPLIANCETM Compliant. Actionable. Ethical. THE The Gold Standard of GOLD Medication Reviews STANDARD CoPs-Compliant Med Reviews. Complete evaluation of medication history. EPCS Certified for controlled substances. Detailed clinical insights with actionable recommendations. Reduces lost and unfilled prescriptions. Less risk of adverse drug Drug Utilization Review shows cost-effective interactions and reactions. $ alternatives, recommends discontinuation of non-palliative medications. Fewer prescribing and dispensing errors. Covered vs. Non-covered medications: We provide industry-best practices for hospice and palliative medication coverage. CMS Reporting Recommendations on drug effectiveness, side effect CR-8358 and 10573 imported into your risks vs. drug benefits, interactions, duplicate EMR via SFTP. therapies, and drug therapy concurrently associated with laboratory monitoring. Opioid laxative report. Adverse Drug Reaction Reports. HCPCS coding. Alerts for inappropriate coverage The 5 Rights to a by Medicare Part D. Medication Pass The Best = Outcome The Right For the At the With the Right In the Right Drug Right Patient Right Time Route of Dosage Form Administration Introducing: Tru360TM Tru Partnership. Tru Customization. Tru Service.TM Tru360 is the most comprehensive, hospice-centered, patient-focused solution in the market today. Tru360 drives sustained cost reduction while improving patient satisfaction and outcomes. Tru360 is built on five key components that produce excellent end-of-life care in a cost-effective manner. PARTNERSHIP EFFICIENCY Real Collaboration. Powered by People. Intuitive Workflow. Proactive Intervention. Driven by Data. Real Results. We build a custom service model to fit your Our technology provides proactive intervention, workflow and your culture. Your Tru360 Team, streamlines pharmacy interaction and saves up including a dedicated pharmacist and account to $2,000 per nurse annually.
    [Show full text]
  • 2018 National Healthcare Quality and Disparities Report
    NATIONAL HEALTHCARE QUALITY & DISPARITIES REPORT 2018 2015 National Healthcare Quality and Disparities Report and National Quality Stategy 5th Anniversary Update c This document is in the public domain and may be used and reprinted without permission. Citation of the source is appreciated. Suggested citation: 2018 National Healthcare Quality and Disparities Report. Rockville, MD: Agency for Healthcare Research and Quality; September 2019. AHRQ Pub. No. 19-0070-EF. 2018 NATIONAL HEALTHCARE QUALITY AND DISPARITIES REPORT U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov AHRQ Publication No. 19-0070-EF September 2019 www.ahrq.gov/research/findings/nhqrdr/index.html ACKNOWLEDGMENTS The National Healthcare Quality and Disparities Report (QDR) is the product of collaboration among agencies from the U.S. Department of Health and Human Services (HHS), other federal departments, and the private sector. Many individuals guided and contributed to this effort. Without their magnanimous support, the report would not have been possible. Specifically, we thank: Primary AHRQ Staff: Gopal Khanna, Francis Chesley, Virginia Mackay-Smith, Jeff Brady, Erin Grace, Karen Chaves, Nancy Wilson, Darryl Gray, Barbara Barton, Doreen Bonnett, and Irim Azam. HHS Interagency Workgroup (IWG) for the QDR: Susan Jenkins (ACL), Irim Azam (AHRQ), Barbara Barton (AHRQ), Doreen Bonnett (AHRQ), Karen Chaves (AHRQ), Fran Chevarley (AHRQ), Camille Fabiyi (AHRQ), Darryl Gray (AHRQ), Kevin
    [Show full text]
  • Telehealth After COVID-19: Clarifying Policy Goals for a Way Forward
    January 2021 Perspective EXPERT INSIGHTS ON A TIMELY POLICY ISSUE LORI USCHER-PINES, MONIQUE MARTINEAU Telehealth After COVID-19 Clarifying Policy Goals for a Way Forward n March 2020, the coronavirus disease 2019 (COVID-19) pandemic shut- tered communities and disrupted the health care delivery system. But clini- Icians quickly dusted off their webcams and leveraged telehealth to continue care—and keep their practices afloat—while still meeting social distancing guidelines. Temporary, dramatic policy waivers (see box) broadened access to and payment for telehealth on an unprecedented scale. These policy changes led to skyrocketing telehealth use in spring 2020. At the time, there was a lot of talk about how tele- health’s time had finally arrived, and how genies were not returning to their bottles. But that might be the wrong metaphor for telehealth use in 2020. The surge in tele- health use had ebbed somewhat by the summer months (Mehrotra et al., 2020), and it is too soon to tell whether the initial enthusiasm for virtual visits was borne of desperation (Uscher-Pines, 2020) or whether some of the newfound appreciation for telehealth can persist under the right policy conditions. C O R P O R A T I O N Federal Telehealth Restrictions Temporarily Changed During the Public Health Emergency and Responsible Agency or Legislation Medicare • Expand the types of providers that can furnish and are eligible to bill Medicare for telehealth services (Coronavirus Aid, Relief, and Economic Security [CARES] Act) • Allow providers eligible to bill
    [Show full text]
  • Pre-Med & Other Health Programs
    PRE-MED & OTHER HEALTH PROGRAMS Berkeley offers excellent undergraduate preparation for medical and other health-related professional schools and sends an impressive number of students on to these graduate programs each year. Cal, like most universities, does not offer a specific “pre-med” major. Few colleges in the United States do, because there is no specific major required for admission to medical or other health- related schools. All students obtain a bachelor’s degree before admission to medical school. For students seeking admission to dentistry, veterinary medicine, optometry, and other health- related graduate programs, many have received a bachelor’s degree prior to admission. What should I major in at Berkeley, AP credits will not satisfy prerequisites at most Does it make a difference where I if I want to go to medical school? medical schools.) Select an academic major that complete my academic preparation for interests you and allows flexibility in taking the There is no preferred pre-med major. Every year medical or other health-related schools? required pre-med courses. students with majors in the social sciences, The quality and reputation of the college or humanities, chemistry and engineering are What should I do when I’m not in class? university from which you graduate can play a accepted to medical school from Berkeley. role in your acceptance to a medical school. If you want to study biology at Berkeley, you One option is to experience the health care The high quality of Berkeley students and can choose from more than 25 areas of environment in a paid or volunteer position during the campus’ worldwide academic reputation specialization in the biological sciences, such college.
    [Show full text]
  • Massachusetts Board of Registration in Pharmacy Published to Promote Compliance of Pharmacy and Drug Law
    August 2020 News Massachusetts Board of Registration in Pharmacy Published to promote compliance of pharmacy and drug law 239 Causeway Street, 5th Floor • Boston, MA 02114 • www.mass.gov/dph/boards/pharmacy Acute Use Medications for Inpatient also known as automated dispensing machines and automated Hospice Facilities dispensing cabinets. In March 2020, a circular letter was jointly issued from the The use of an ADD in a Massachusetts-licensed health care Massachusetts Board of Registration in Pharmacy and the facility is permitted only if the facility’s licensure allows it to Bureau of Health Care Safety and Quality outlining a process store and dispense medications. For instance, if there is not through which an inpatient hospice facility’s pharmacy pro- an on-site pharmacy, prior approval for use and placement vider may store certain non-patient-specific medications at of the ADD must be obtained from the agency that licenses the facility. With this change, hospice inpatient facilities (as that facility. defined in105 Code of Massachusetts Regulations 141.000) Medications must be provided in unit-of-use packaging for will now have the ability to treat patient symptoms that are a single dose or a specific person and remain the property of not life-threatening, but require medication management the pharmacy until dispensed pursuant to a patient-specific in a timely manner to provide prompt palliative care. A list prescription or order. Any losses must be reported to the of medications that may be stored, as well as details on the pharmacy’s licensing body (ie, Board of Pharmacy or Drug requirement to store them in an automated dispensing device Control Program).
    [Show full text]