Client Summary Palliative Care

Client Summary

Palliative Care

DRAFT 2, March 2014

Gippsland Region

Palliative Care Consortium

Clinical Practice Group

Policy No. GRPCC

Title Client Summary Palliative Care Keywords After-hours, palliative care, triage and

symptom management

Ratified GRPCC Clinical Practice Group Effective Date

Review Date Every two years from effective date. Purpose To specify a minimum client data set

required for:

 best practice care planning; and  effective communication of palliative

care client information between service providers.

Background

The Victorian Department of Health has provided funding to improve after-hours support for

palliative care clients. An After-hours palliative care framework

_{(the Framework) was released}

in 2012 to assist palliative care consortia to develop models of after-hours support for their

regions. Six key elements of an after-hours palliative care model are identified;

1. Best practice care planning

2. Client information systems

3. After-hours telephone triage

4. After-hours nursing support

5. After-hours medical support

6. Activity following an after-hours contact and quality assurance

While developing a Gippsland After-Hours Palliative Care Model, the GRPCC identified a need

for a Client Summary Palliative Care. The purpose of this document is to specify a minimum

client data set required for:



best practice care planning; and



effective communication of palliative care client

information between service providers.

Therefore, the Client Summary Palliative Care addresses the following key elements of the

Framework:

1. Best practice care planning is facilitated by completing all items in the Client Summary

Palliative Care.

2. Client information systems should incorporate the Client Summary Palliative Care items.

3. After-Hours telephone triage will be better informed by the Client Summary Palliative

Care, providing the triage nurse with relevant information required to successfully triage

any after-hours phone calls.

The Client Summary Palliative Care will also assist communication more broadly than after-hours

service provision for palliative care clients. Any communication with other service providers will

be more informed if all items in the Client Summary Palliative Care is completed, e.g. secondary

consultations, referrals etc….

Appendix 1 – Sample form - Client Summary Palliative Care

Patient name Date of Birth

Home address Gender

Phone – home Phone – mobile

Patient living alone □ Yes □ No

GP Available - home visits □ Yes □ No

name and phone Contactable by phone

after-hours □ Yes □ No

Main carer Relationship

Address (if different to patient address)

Phone

Admission to service

date

Reason for admission Main diagnosis Medical history Client alerts

Cautions / allergies/ risk management

Phase of illness

PTO for definitions

Karnofsky scale

PTO for definitions

Current treatments chemotherapy, radiotherapy, other, Not applicable

Current symptoms; Physical, Psychosocial and Other Problem severity score 0-3

PTO for definitions

Phase Definitions The Palliative care phase is the stage of the patient’s illness. Palliative

care phases are not sequential and a patient may move back and forth between phases. Palliative care phases provide a clinical indication of the level of care required and have shown to correlate strongly with survival within longitudinal prospective studies.

PALLIATIVE CARE PHASE OF ILLNESS

Clinician rated

1. STABLE Symptoms are adequately controlled by established management

2. UNSTABLE Development of a new problem or a rapid increase in the severity of existing problems 3. DETERIORATING Gradual worsening of existing

symptoms or the development of new but expected problems

4. TERMINAL Death likely in a matter of days 5. BEREAVED Death of a patient has occurred and

the carers are grieving

Refer to complete Phase Definitions

KARNOFSKY SCALE

AKPS (Australian modified Karnofsky Performance Scale)

Clinician rated

100 Normal, no complaints or evidence of disease 90 Able to carry on normal activity, minor signs or activity

80 Normal activity with effort, some signs or symptoms of disease

70 Care for self, unable to carry on normal activity or to do active work

60 Occasional assistance but is able to care for most needs

50 Requires considerable assistance and frequent medical care

40 In bed more than 50% of the time 30 Almost completely bedfast

20 Totally bedfast & requiring nursing care by professionals and/or family

10 Comatose, barely rousable

PROBLEM SEVERITY SCORE

Clinician rated 0 = Absent 1 = Mild 2 = Moderate 3 = Severe

Appendix 1 – Sample form - Client Summary Palliative Care

Current signed anticipatory medication and syringe driver orders Doses

Are anticipatory medication and syringe driver orders available in the home? □ Yes □ No Is injectable medication available in the home? □ Yes □ No Are syringes/needles available in the home? □ Yes □ No

Is there a sharp container in the home? □ Yes □ No

Planning

Does the client want to be cared for

at home?

□

□

Is the caregiver managing

care at home?

□

□

Does the client want to die at home?

□

□

client to die at home?

□

□

Date commenced Date completed

Carer’s Kit provided

Advance Care Planning (ACP) End of Life Care (EOLC) Planning

Medical Enduring Power of Attorney (MEPOA) Funeral arrangements made

Comments:

Appendix 2 – Sample form – After-Hours Call Summary

Person making after-hours phone call: Client Caregiver Other ………...

Reason(s) for call

Symptom related New Exacerbation Problem severity score 0-3

PTO for definitions Notes

Pain

Anxiety- client / caregiver Nausea and/or vomiting Breathlessness Terminal restlessness Constipation Death Other symptom Other reason(s)

Response to call _{Yes No Notes}

Issue resolved through phone call only Home visit after-hours required

Visit recommended following day Contacted palliative care nurse Ambulance called

Admission to hospital

Other response