Carole Morgan RN, MPA LNHA

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Palliative Care

• Carole Morgan RN, MPA LNHA
• Marian McNamara RN,MSN

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Faculty Disclosures

• Carole Morgan RN. Director of Nursing
• Marian McNamara RN. Associate Director of Nursing
• Sea View Hospital Rehabilitation Center
• And Home

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Learning Objectives

• By the end of the session, participants will be
  able to
• Implement a Successful Palliative Care Program.
  
• Implement a forum to allow staff to express their
  feelings related to death and dying.
• Identify 3 Quality outcomes as a result of the
  implementation of the Palliative Care Program

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Facility Demographics

• Sea View is one of 16 facilities in the New York
  City Health and Hospitals Corporation
• 304 Bed Facility located in Staten Island, NY.
• 22 Bed Traumatic Brain Injury Unit
• 76 Bed Alzheimer Unit

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Problem Statement

• In LTC death is often prolonged and hospice is
  not always a feasible option
• Interdisciplinary staff not familiar with
  Palliative care

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Goals

• Establish a Palliative Care program that provides
  a Comphrehensive Interdisciplinary approach to
  prepare residents and families for coping with
  expected end of life.
• Relieve suffering and pain by aggressively
  treating symptoms with both Pharmacologic and
  Non-Pharmacologic approaches.
• A Forum for the staff to express feelings related
  to multifaceted End of Life issues.

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Implementation

• Development of Interdisciplinary team
• Development of Educational Curriculum
• Develop a Policy and Procedure incorporating
  Advanced Directives
• Revision of pain management program including
  assessment and interventions
• Palliative Care Handbook
• Tea and Comfort program

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Interdisciplinary Team

• Medicine
• Nursing
• Social Work
• Activities
• Pastoral care
• Dietary
• Pharmacy

• Front line caregivers RN, LPN, PCTs
• Housekeeping
• Resident Representative
• Care Planning Coordinator

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Educational Curriculum

• Palliative Care for Nursing Homes at Fordham
  University
• EPEC Training 12 module/60 min
• Train the Trainer sponsored by ELNEC 2 day
  intensive curriculum
• Visit to Calvary Shriver's Hospital
• Conferences Membership to HPCANYS
• On-going education through CAPC

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Advanced Directives

• Developed and Implemented Policy on Palliative
  Care with emphasis on early discussion of
  Advanced Directives
• Discussion on Advanced Directives begins upon
  admission, and at each Interdisciplinary Team
  Conference
• Ethic committee convenes as needed to discuss
  bio-ethical concerns.
• Feeding Tube use has decreased from 14.6 in 2004
  to 11.6 in 2009

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Pain Management Program

• Complete revision of assessment tool to include
  verbal and non-verbal assessment (admission,
  readmission, new onset, and significant change)
• Palliative care physician takes lead in
  pharmological therapy which includes scheduled
  dosing instead of PRNs
• Incorporated non-pharmacological interventions in
  our practice
• Moderate to Severe pain indicator has gone from
  6.4 in 2004 to 2.7 in 2009.

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Sensory Room
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Palliative Care Handbook

• Commenced in 2004 completed in 2007
• 14 page document that is easily replicated
• Resource guide for Residents, Families and Staff
• Developed by the Interdisciplinary team based
  upon area of expertise on a specific topic

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Tea and Comfort

• Tea is the universal symbol of comfort and
  friendship
• Combination of staff education and support.
• Allows staff to express their own feelings in
  relation to death, dying and human suffering.
• Encompasses Stress reduction techniques such as
  biofeedback, Reiki, message, meditation, prayer
  and music.

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Enhanced Staff Performance

• Empowered staff to embrace comfort care as well
  as curative care.
• Prepared staff to help resident/families make
  informed decision as it relates to advanced
  directives.
• Provision of Palliative Care Carts to each
  resident unit.
• Increased knowledge of the pain management
  process and the use of non-pharmological
  approaches

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Lessons Learned

• To effectively implement change it takes time,
  patience, trial and error.
• Staff become experts, with extensive education
  and working with real life issues.
• For the program to be effective allow staff an
  outlet to express their personal feelings
• Share best practices between facilities for
  growth and quality care
• Palliative Care program has had significant
  impact in regard to resident satisfaction and
  quality of life

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• Those who have the strength and the love to sit
  with a dying patient in the silence that goes
  beyond words will know that this moment is
  neither frightening nor painful, but a peaceful
  cessation of the functioning of the body. E.
  Kubler Ross