Joan Doran, Program Lead

27 April 2011

Overview of HPC Teams Education Project

Working Together to Support Best Practices in Palliative Pain &

Symptom Management for LTC Residents

Objectives

1. Update re HPC Teams

2. Overview of capacity building projectsEducation for LTC Homes & Community

Primary Providers

Physician survey

Physician liaison with HPC Teams

3. Input re Education Project

Program Background

Partnership:

• Central CCAC

• Temmy Latner Centre

• Southlake Regional Health Centre

Funding:

• Aging at Home, Central LHIN

• PPSM

MOHLTC:• 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)

Regional Cancer Centre'sResidential Hospices

Hospital PCU's LTC Homes Respite Care Retirement

Homes

Community SupportsFaith Groups

FriendsCommunity Organizations

Palliative Care PhysicianMental Health Consultant

CNC Team

Visiting / Family PhysicianPrimary Nurse

CCAC Case ManagerPSW

Allied Health (PT, OT, SLP, DT)Social Worker

Pharmacist Laboratory Hospice Spiritual

Support

Patient / Family

COMMUNICATION

HPC Teams for Central LHINModel for Hospice Palliative Care

Tertiary / Residential Team

Informal Team

Expert Team

Core Team

Advisory Council

• Dr. Nancy Merrow• Dr. Larry Librach• Dr. Russell Goldman• Evelyn Rosen• Joan Doran• Anne Grant

Clinical Nurse ConsultantsCNC Areas

Christine

Alguire

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

Oct Nov Dec Jan Feb Mar0

50100150200250300350400

75 73 5588 67 83

315 321295 313

344 328

Referrals / CaseloadsOctober 2010 - March

2011ReferralsCaseloads

Oct Nov Dec Jan Feb Mar0

500

1000

1500

2000

12011482

11391480

1197 1274

ContactsOctober 2010 - March

2011

Contacts

Home Visits• Home Visits represent in-

home consultation with Health Care Professional

ER Avoidance

• ER visits documented by CNC, Visiting Nurse and CCAC

• ER ‘visits avoided’ entered into HPC database when CNC consultation prevents patient going to ER for PP&SM

Oct Nov Dec Jan Feb Mar0

20

40

60

80

100

120

140

91

120

97 10288

110

Home VisitsOctober 2010 - March

2011

Home Visits

Oct Nov Dec Jan Feb Mar0

10

20

30

40

50

60

70

32 2922 25

18 1913

33

15

3641

62

ER Visits / Visits AvoidedOctober 2010 - March 2011

ER VisitsER Visits Avoided

Deaths Place of Preference

Collect data on place of death and % who die in place of choice

• For patients who identified a place of preference for death in their plan, October 2010– March 2011 85% achieved their goal

Oct Nov Dec Jan Feb Mar0

1020304050

30

4539 38 42 40

11 8 9 72 5

Deaths in Place of Preference

October 2010 - March 2011

Meets Pref-erence

Oct Nov Dec Jan Feb Mar0%

50%

100%

150%

73% 85% 81% 84% 95% 89%

% Died In Place of Pref-erence

October 2010 - March 2011

% Died in Place of Preference

Oct Nov Dec Jan Feb Mar

Total # Deaths 50 57 55 51 46 47

5

35

50 57 55 51 46 47

Total # Deaths October 2010 - March

2011

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 InterestInterviewed & selected 4 LTC homes

Representation across LHIN

Gap analysis

Collaborated with NLOTDeveloping 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