Strategic Steps in Starting a Palliative Care Team

Why?

  • The right thing to do
  • Treats patients the way they want to be treated
  • Supports the family
  • Affirms nurses in their caring profession
  • Reduces costs
  • Complies with JCAHO standard RI.1.2.8-“The hospital addresses care at the end of life.”

How do we get started?

  • Needs assessment (see p. 7 in the Primer, Planning a Hospital-based Palliative Care Program)
    • Chart review
    • Financial review

What services will the palliative care team provide?

  • Pain and symptom assessment and management
  • Assistance in making difficult decisions about use or withdrawal of life support such as CPR, mechanical ventilation, feeding tubes, or dialysis
  • Assistance in planning for the most appropriate care setting and care givers to meet patient/family goals for end-of-life care
  • Psychosocial and spiritual support to patients, families, and the health care team before, during, and after the time of death (bereavement support)

Which patients?

  • Patients who are chronically and terminally ill
    • Patients with cancer (50%)
    • Patients with other end-organ disease (heart, lungs, kidneys, nervous system)
    • Patients with AIDS

How do we get buy-in?

  • Educate physicians, nurses, pharmacists, dietitians, and chaplains
  • Educate physical therapists and others involved in rehabilitation
  • Educate case managers
  • Educate patients and families
  • Make rounds with physicians, nurses, and case managers

Where do we get the finances to tart a service?

  • Gather data
  • Analyze data
  • Educate hospital administration
  • Already spending the money inefficiently

What do we need to start?

  • Nurse to coordinate the service
    • Carries a beeper and responds to consults
    • Palliative care training-ELNEC, Hospice, Oncology, CAPC
    • Reviews cases as needed with physician medical director
  • Physician medical director
    • Palliative care training-EPEC, Hospice
    • Time to do consultations as needed

Recruit the rest of the team

  • Pharmacist
  • Chaplain
  • Case manager
  • Psychiatrist
  • Pain Service

Administrative support

  • Secretary
  • Phone
  • Computer
  • Beeper
  • Office