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Palliative Care: Quality, Risk & Patient Safety Cheat Sheet by

Palliative Care: Quality, Risk & Patient Safety
care     safety     patient     risk     quality     healthcare     palliative     end-of-life

Provision of facili­ty-­based palliative care

This approach involves ensuring that there is a common unders­tanding of palliative care in the nursing home setting, identi­fying and
closing gaps in staff training and clinical skills, providing staff with tools and resources to help timely identify residents for whom palliative care may be approp­riate, developing orimpr­oving an infras­tru­cture that supports the provision of palliative care, and monitoring for quality and sustai­nab­ility. (Strumpf et al.)

Charac­ter­istics of quality, sustai­nable palliative care programs include the following:
Strong and committed leadership
Active involv­ement of the medical director
Program implem­ent­ation guided by a nurse with expertise in hospice and palliative care
Availa­bility of a facility champion
Organi­zat­ional change that is "­bottom up" and "top down"
Implem­ent­ation of palliative care in smaller, manageable increments
Inclusion of all staff, from housek­eeping to admini­str­ation
Conduct of regular meetings for discussion of palliative care
Integr­ation of palliative care into daily practice by mainta­ining palliative care residents within existing unit struct­ures.

Quality, Risk, and Patient Safety

The provision of palliative care entails familiar and unique quality, patient safety, regula­tory, and litigation risks. Expert advisors on perfor­mance measure coordi­nation strategy for quality palliative and hospice care suggest an approach that emphasizes clinically focused quality measures but also expands to include measures that follow the patient and the patient's full set of experi­ences (NQF). The 2013 National Consensus Project for Quality Palliative Care's clinical practice guidelines identify eight domains (NCP):

1. Structure and process of care

a. Coordi­nated assessment and continuity of care
b. Interd­isc­ipl­inary team collab­oration and engagement with patients and families

2. Physical aspects of care

a. Management of pain and distre­ssing symptoms
b. Safe prescr­ibing of controlled medica­tions

Pallitive Care

3. Psycho­log­ica­l/p­syc­hiatric aspects

a. Assess­ment, diagnosis, treatment, and bereav­ement program

4. Social aspects of care

a. Palliative care social assessment to identify and support family strengths

5. Spiritual, religious & existe­ntial Care Aspects

a. Palliative care teams include an approp­riately trained chaplain to assess and attend to spritual issues of patients and families and to support religious and spiritual rituals for comfort and relief

6. Cultural aspects of care

a. Promotes cultural competence for the interd­isc­ipl­inary team, including language, literacy, and lingui­sti­cally approp­riate service delivery

7. End-of­-life care

a. Commun­ication and docume­ntation of symptoms of the dying process among patient, family, and caregivers
b. Assessment and management of pain
c. Guidance to families about the dying process
d.Bere­avement support

8. Ethical and legal aspects of care

a. Advance care planning, ethics, and legal aspects of care
b. Seeking advice and counsel from ethics committees
c. Scope-­of-­pra­ctice issues
d. Legal and regulatory compliance

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