PALLIATIVE CARE OUTCOMES COLLABORATION PCOC Ongoing Education

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PALLIATIVE CARE OUTCOMES COLLABORATION
(PCOC)Ongoing Education
Funded by the Australian Government
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What is PCOC?

• PCOC is a national approach towards the routine
  assessment of palliative care outcomes to assist
  palliative care service providers to deliver
  quality patient care

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PCOC is

• Continuous quality development of palliative care
• Demonstrating outcomes (service and
  patient/caregiver)
• Using standardised palliative care assessments
• Using a common language
• Providing a benchmarking process

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What Happens to the data?

• In this service..
• Uploaded into PCOC national database
• 6mthly report compares your service against all
  other PCOC services

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PCOC Information levels

• Level 1 Patient- demographic
• Level 2 Episode- setting of care
• Level 3 Phase- clinical

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Level 1 - Patient Information

• Patient identifier
• Date of birth
• Sex
• State identifier
• Postcode
• Indigenous status
• Main language spoken at home
• Country of birth

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Level 1 Patient Information

• Collect at episode start only
• This information is collected by . in our
  service on . form

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Level 2 - Episode Information

• Episode tells us about the setting and how they
  enter and exit this setting
• Episode A period of contact between a palliative
  care patient and a palliative care service that
  is provided by one palliative care service and
  that occurs in one setting (either admitted
  patient care or ambulatory patient care)

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Level 2 - Episode Information

• Service Responsiveness
• Where the patient was referred from
• Length of episode
• How the episode ended
• Diagnosis

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Level 2 Episode Information

• Collect at episode start
• Collect at episode end
• Procedure for collecting information in our
  service
• This information collected by . in our service

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Level 3 - Phase Information

• Condition of patient acuity, progression of
  phases
• Functional Status
• Performance Status
• Symptom Control
• Problem Severity Distress
• Length of Phase

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Assessment tools

• Phase
• RUG - ADL Resource Utilisation Groups
  Activities Daily Living
• Australian Karnofsky Performance Measure
• Palliative Care Problem Severity Scale
• Symptom Assessment Scale

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Phase Assessment

• Stable
• Unstable
• Deteriorating
• Terminal
• Bereaved

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Phase Assessment

• The palliative care phase is the stage of a
  persons illness
• An assessment is holistic and views the patient
  and family as one unit
• Palliative care phases are not sequential. A
  patient/family may move back and forth between
  phases

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Stable Phase 1

• The patients symptoms are adequately controlled
  by established management. Further interventions
  to maintain symptom control and quality of life
  have been planned
• The situation of the family/carers is relatively
  stable and no new issues are apparent. Any needs
  are met by the established plan of care

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Unstable Phase 2

• The patient experiences the development of a new
  unexpected problem or a rapid increase or
  decrease in the severity of existing problems,
  either of which require an urgent change in the
  management or emergency treatment
• The family/carers experience a sudden change in
  their situation requiring urgent intervention by
  members of the multidisciplinary team

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Deteriorating Phase 3

• The patient experiences a gradual worsening of
  existing symptoms or the development of new but
  expected problems. These require the application
  of specific plans of care and regular review but
  not urgent or emergency treatment.
• The family/carers experience gradually worsening
  distress and other difficulties, including social
  and practical difficulties, as a result of the
  illness of the person. This requires a planned
  support program and counselling as necessary.

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Terminal Phase 4

• Death is likely in a matter of days and no acute
  intervention is planned or required
• The family/carers recognise that death is
  imminent and care is focussed on emotional and
  spiritual issues as a prelude to bereavement
• Some signs of this phase may include
• Profoundly weak
• Essentially bed bound
• Drowsy for extended periods
• Disoriented for time and has a severely limited
  attention span
• Increasingly disinterested in food and drink
• Finding it difficult to swallow medication

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Bereaved Phase 5

• Patient has died and bereavement support is
  offered
• A planned bereavement support program is
  available including referral for counselling as
  necessary
• Record only one bereavement phase per patient
  not one for each family/carer member

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Phase

• At episode start
• At phase change or discharge / case closure
• In this service -

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RUG- ADL

• The RUG-ADL is a 4 item scale measuring motor
  function with activities of daily living
• Bed mobility
• Toileting
• Transfer
• Eating
• RUG-ADL tells us about the patient's functional
  status and the assistance they require for their
  activities of daily living

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RUG-ADL

• Determine the score for each of the 4 domains,
  and total the score
• Minimum score is 4 - maximum is 18
• Total score 4 person is independent
• Total score 18 person requires total assistance
  of 2 persons
• Record what the person actually does, not what
  he/she is capable of

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RUG-ADL

• At episode start
• At phase change or discharge / case closure
• In this service -

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Australian Karnofsky Performance Scale

• Assesses performance status
• Assesses 3 dimensions of health status
• Activity
• Work
• Self care

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Australian Karnofsky Performance Scale
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Australian Karnofsky Performance Scale

• At episode start
• At phase change or discharge / case closure
• In this service -

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Problem Severity Score

• A score for the overall degree of distress
• Includes a specific rating for the family
• Is assessed by the clinician

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Problem Severity Score

• Measure includes four domains
• pain
• other symptoms
• psychological/spiritual
• family/carer
• The descriptors for PSS are

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Problem Severity Score

• Pain
• The degree of overall pain

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Problem Severity Score

• Other Symptoms
• Record the degree of distress
• The following list may be used as a guide
• Nausea/vomiting Confusion/delirium
• Anorexia Dyspnoea
• Itch/irritation Oedema
• Constipation/diahorrea Incontinence
• Wound/ulcer Weakness/fatigue

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Problem Severity Score

• Psychological / Spiritual
• Record the score for overall degree of
  psychological/spiritual problems of the patient
• The following list may be used as a guide
• Anxiety/fear Request to die
• Anger Agitation
• Depression/sadness Confusion
• Unrealistic goals

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Problem Severity Score

• Family / Carer
• Record score for the overall degree of family /
  carer problems 0-3
• The following list may be used as a guide
• Cultural Family/carer accommodation
• Anger Sensory impairment
• Financial Unrealistic goals
• Denial Caregiver fatigue
• Non-English speaking Legal
• Difficult communication
• Family/carer conflict

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Problem Severity Score

• At episode start
• At phase change or discharge / case closure
• In this service -

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Symptom Assessment Scale

• Assesses symptoms from the patients perspective
• Identifies the patients priorities in terms of
  distress
• Allows you to track individual symptoms over time
  for each patient
• Helps staff to identify the effectiveness of
  clinical interventions
• Changes in symptoms, improvements or
  deterioration, can be measured

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Symptom Assessment Scale

• Seven key symptoms
• 1. insomnia
• 2. appetite problems
• 3. nausea
• 4. bowels
• 5. breathing
• 6. fatigue
• 7. pain
• Ratings are recorded to demonstrate the patients
  progress and changes in condition
• Other symptoms can be added

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Symptom Assessment Scale

• This assessment requires effective communication
  skills
• It involves incorporating a rating of a symptom
  into conversations with the patient

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Symptom Assessment Scale

• At episode start
• At phase change or discharge / case closure
• In this service -

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Case Study

• Refer to your handouts for case study details
• In groups undertake assessments
• Discuss results

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Outcomes

• Data to evaluate palliative care
• Use of common assessment tools
• Better understanding about what palliative care
  does

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Outcomes
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Outcomes
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Outcomes
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Outcomes
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Discussion