Overview of HPC Teams Education
Project
Working Together to Support Best
Practices in Palliative Pain &
Symptom Management for LTC
Residents
Joan Doran, Program Lead
27 April 2011
Objectives
1.
Update re HPC Teams
2.
Overview of capacity building projects
Education for LTC Homes & Community
Primary Providers
Physician survey
Physician liaison with HPC Teams
3.
Input re Education Project
Program Background
•
Partnership: •
Funding:
MOHLTC:
Central CCAC
Temmy Latner Centre
•
Southlake Regional Health Centre
•
Aging at Home, Central LHIN
•
PPSM
•
Mandate
Program Mandate
•
Assists primary providers in application of the
Model to Guide HPC assessment tools & best
practice
•
Offers consultation to primary providers
about palliative assessment, pain and
symptom management
 In person,
 By telephone, teleconference, or
 Through e-mail
(MOHLTC, 2006)
Program Mandate
•
Case-based education & mentoring for primary
providers
•
Capacity building amongst front-line service
providers re delivery of palliative care
•
Links providers with specialized hospice
palliative care resources
(MOHLTC, 2006)
HPC Teams for Central LHIN
Model for Hospice Palliative Care
Regional Cancer Centre's
Residential Hospices
Hospital PCU's
LTC Homes
Respite Care
Retirement Homes
Community Supports
Faith Groups
Friends
Community Organizations
Tertiary /
Residential Team
Informal
Team
Palliative Care Physician
Mental Health Consultant
CNC Team
Visiting / Family Physician
Primary Nurse
CCAC Case Manager
PSW
Allied Health (PT, OT, SLP, DT)
Social Worker
Pharmacist
Laboratory
Hospice
Spiritual Support
Patient / Family
Expert
Team
Core
Team
Advisory Council
•
•
•
•
•
•
Dr. Nancy Merrow
Dr. Larry Librach
Dr. Russell Goldman
Evelyn Rosen
Joan Doran
Anne Grant
Clinical Nurse Consultants
CNC
Christine Alguire
Areas
Alliston, Bradford, Beeton, King, Maple,
Schomberg, Tottenham & Vaughan
Mamdouh Rezk
Richmond Hill & Thornhill
Margaret Cutrara
Markham & Stouffville
Juliana Howes
Aurora, East Gwillimbury, Georgina,
Newmarket
Carolyn Willson
North York
HPC Program Criteria
•
Patients with a progressive, life threatening illness
&/or facing end of life issues
•
Primary intent of treatment is palliative whether
palliation of disease, palliation of symptoms
(physical, psychological, social)
•
Patient & family agree to referral or to consultative
support
•
DNR/No Code status is not required for entry onto
the program
•
Unmet symptom management needs of all types
Role of the CNC
•
Supporting health care professionals - not
replacing the primary providers
•
Professional consultation re PP&SM in the
community & LTC
•
Capacity building targeting the knowledge
& provision of palliative care
CNC Role
•
Facilitation & education at Interprofessional
Rounds
•
Networking with health care teams within
each geographical region
•
Leadership in standardizing palliative care
practice: EDITH, SRK, In-Home Chart
•
Educational initiatives in Central LHIN
CCO Toolbox

Common Tools

Isaac

Collaborative Care Plans

Symptom Management Guidelines
Referral Process
•
Majority of HPCT referrals from CCAC
•
Community nurses or physicians refer
directly: telephone or email
•
Nursing agency or LTC can request a
CNC for one or more of their staff
Referral Process (cont’d)
•
HPC Teams will admit, reassess
immediate needs & contact providers
•
CNC provides consultation report for the
physician, CCAC CM, Primary
Professional
•
CNC follows the client case with the
professional
REPORTS ON
ACTIVITY
•
•
Referrals and caseloads
increasing as awareness
of program grows
Each contact with a
primary provider to
provide recommendations
re care plan and pain &
symptom management
Referrals / Caseloads
October 2010 - March 2011
400
350
300
250
200
150
100
50
0
315
321
295
313
344
328
Referrals
75
73
Oct
Nov
55
Dec
88
Jan
67
83
Feb
Mar
Caseloads
Contacts
October 2010 - March 2011
1600
1400
1200
1000
800
600
400
200
0
1482
1201
1480
1197
1139
1274
Contacts
Oct
Nov
Dec
Jan
Feb
Mar
Home Visits
October 2010 - March 2011
Home Visits
•
140
120
120
Home Visits represent inhome consultation with
Health Care Professional
91
100
110
102
97
88
80
Home
Visits
60
40
20
ER Avoidance
•
0
Oct
ER visits documented
by CNC, Visiting Nurse
and CCAC
Nov
Dec
Jan
Feb
ER Visits / Visits Avoided
October 2010 - March 2011
70
•
ER ‘visits avoided’
entered into HPC
database when CNC
consultation prevents
patient going to ER for
PP&SM
Mar
62
60
50
40
32
30
20
36
33
29
22
15
13
41
ER Visits
25
18
19
Feb
Mar
10
0
Oct
Nov
Dec
Jan
ER Visits Avoided
Deaths
Place of Preference
Collect data on place of death and
% who die in place of choice
Total # Deaths
October 2010 - March 2011
60
50
40
30
20
10
0
Total # Deaths
50
57
55
51
46
47
Deaths in Place of Preference
October 2010 - March 2011
50
40
30
20
45
39
42
38
40
30
Meets Preference
11
10
8
9
7
2
5
0
Oct
50
Nov
57
Dec
55
Jan
51
Feb
46
• For patients who identified a
place of preference for death in
their plan, October 2010– March
2011 85% achieved their goal
Oct
Mar
47
Nov
Dec
Jan
Feb
Mar
% Died In Place of Preference
October 2010 - March 2011
120%
100%
80%
60%
40%
20%
0%
73%
85%
81%
84%
95%
89%
% Died in Place of
Preference
Oct
Nov
Dec
Jan
Feb
Mar
Program Hours
•
Core hours, 0830-1630 Mon-Fri
•
After hours on-call available
•
CNCs provide consultation for all health
care professionals
•
After Hours Phone: 905-954-5220
Contacting HPC Teams
Catherine Bazowsky, Administrative Assistant
Phone:
(905) 895-4521, ext. 6388
Fax:
(905) 830-5978
Email:
HPCTeams@Southlakeregional.org
Website:
http://centralhpcnetwork.ca/hpc/hpcteams.html
LTC Home Education Project

Funded by Central LHIN

Provide support to LTC homes in the
provision of quality end-of-life care

Increase knowledge transfer for the
health care team
Outcomes

Reduction in ER visits

Enhanced Pain and Symptom
Management

Enhanced communication with
residents/families

Increase utilization of Advance Care
Planning
Process

Requested Expression of Interest

Interviewed & selected 4 LTC homes

Representation across LHIN

Gap analysis

Collaborated with NLOT

Developing curriculum

Physician & RN/RPN

PSW
Process (cont)

4 Sessions

On-line Repository of Resources

Case finding among current residents
and case-based mentoring

Program evaluation
Topics

Issues and Challenges in Providing
Quality End-of-Life Care

Advance Care Planning

Working with Families

Pain Management and Last Hours
Education

Hired researcher/education assistant

MD/RN/RPN sessions facilitated by
palliative care physicians, PC experts,
with support from CNC’s

PSW sessions will be led by PalCare
Evaluation

Conduct gap analysis to determine
reasons for ER transfers
 Chart reviews
 Interviews with MD’s, RN, Administration

Based on gap analysis, develop,
implement and evaluate intervention
for quality EOL care
Feedback??

What issues do you identify in
providing high quality EOL care to LTC
residents?

Are palliative patients being sent to
ER? Why?

What needs to be in place to support
LTC residents to die in their home?
Physician Survey
‘Assessment of Service Provision
and Willingness to Engage’
 Developed
by Dr Russell Goldman
and Dr Camilla Zimmerman
– TLCPC/ PMH
Purpose

To determine the level of GP/FP care
being provided to community
homebound patients
Purpose

To identify the proportion of physicians
who provide the following services to
homebound palliative patients:
 Scheduled home visits
 After-hours home visits
 Urgent home visits during office hours
 24/7 coverage with after-hours home
visits as required
Purpose

To determine what supports would
facilitate PCP’s to engage in the care
of homebound palliative patients

Develop a registry of PCP’s who
would be willing to assume care of
patients who do not have access to a
FP
Methodology

Survey all FP who have a primary
practice address in Central LHIN

Mail out survey/ E mail – (OCFP
assisting)

Can complete on-line or mail in survey
Outcomes

Identify barriers to the provision of
home palliative care by FP’s

Inform the design of an intervention to
improve FP capacity and willingness
to provide home based palliative care
Outcomes

Develop a list of FP’s who are willing
to take on additional palliative patients

Results will be presented at national
and international conferences and
published in peer- reviewed journals

Timeline – to be completed within next
6 months
Physician Liaison

Physician roster established to provide
24/7 availability

Provide support to the HCP Teams
CNC’s & FP’s to care for patients in
community
Questions
37