Mitigating opioid errors in inpatient palliative care: A qualitative study
Opioids are high-risk medicines used in high doses and volumes in specialist palliative care inpatient services to manage palliative patients ’ pain and other symptoms. Despite the high volume of opioid use in this care setting, serious errors with opioids are exceedingly rare. However, little is known about the factors that mitigate opioid errors in specialist palliative care inpatient services.
Authors: Haese N, Powers J, Streblow DN Abstract Chikungunya virus (CHIKV) infection in humans is rarely fatal but is often associated with chronic joint and muscle pain. Chronic CHIKV disease is highly debilitating and is associated with viral persistence. To date, there are no approved vaccines or therapeutics to prevent or treat CHIKV infections once they are established. Current palliative treatments aim to reduce joint inflammation and pain associated with acute and chronic CHIKV disease. Development of novel therapeutics that reduces viral loads should positively impact virus inflammatory disease and improve ...
Among seriously ill patients, those with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) arguably receive among the worst end-of-life care. These patients frequently die in the hospital, often after an intensive procedure like cardiopulmonary resuscitation, and with a low referral rate to hospice. There is now a concerted effort in the nephrology and palliative care communities to integrate palliative care into the treatment of these seriously ill patients. The Pathways Project is a national demonstration, funded by the Gordon and Betty Moore Foundation, to develop scalable innovations in kidney supportive care.
Antipsychotics are widely used off-label in clinical practice, especially within palliative care. Palliative care and hospice clinicians often prescribe antipsychotics for off-label uses such as delirium, nausea, agitation, and insomnia even though controversial evidence exists for their use for these indications, given antipsychotics daunting side effect profile. A review of literature of antipsychotics for off-label uses will be completed and supplemented by expert opinion in a debate format as there are known risks and benefits to antipsychotic use, even when used more liberally in the palliative care world.
The palliative care landscape is evolving with new market entrants, growing program sophistication, and increasing interest in implementation strategies from the state and federal level. With the advent of value-based care, this approach to patient care is becoming ever so important to health providers, payers, and patients alike. How can organizations most effectively develop programs around serious illness care when there is change around every corner of our industry? How can we learn from one another to avoid common pitfalls and well-known, but not well-navigated paths forward? Through two separate convenings, one being...
Traditional outpatient clinics can present insurmountable challenges for seriously ill patients resulting in a high no-show rate and limited touch-points with palliative providers. To prevent lapses in care, we will describe how we harnessed video-based telehealth to redefine the boundaries of our PC team to provide effective and efficient patient care outside the walls of our hospitals. Our PATCH (Palliative Telehealth Connecting Hospital to Home) program addresses issues patients face after hospitalization, including symptom and medication management, coordination of care, and psychosocial support.
A hallmark of comprehensive palliative care is an intra-professional team which is expert in addressing physical, spiritual and psycho-social distress. Funding this team can be challenging. Many essential team members are unable to bill insurance for their services, and the structure of insurance payments may not adequately compensate team members, such as nurses and doctors who bill. Therefore, palliative care programs rely on direct financial support from hospitals and philanthropy. Given budgetary challenges facing both community and academic medical centers, the need to maximize relationships with potential donors is paramount.
The practice of hospice and palliative care provides the privilege of presence with patients, families, and colleagues at some of life's most important moments. These moments require close observation, and we often need to connect these observations to infer the deeper meaning for those involved. Within our daily practice and growing clinical demands, nurturing observational skills and reflective capacities in ourselves and our trainees can be a challenge. However, these approaches can be sustaining and restoring.
As with many specialties, it is difficult to sustain palliative care programs in rural areas. This is particularly true in areas such as the Southeast where non-urban hospitals tend to be small and for-profit, two characteristics associated with lacking palliative care services. Early efforts to address rural inequities focused on moving specialists into areas of need, but some of these succumbed to a lack of consistent volume and revenue for the time expended by specialists. More recently, efforts to address rural inequities have shifted to using technology to bridge the distances.
Addressing the emotional difficulties of patients facing serious illness can present a variety of unique challenges. For instance, depressive disorders can have variable presentations across patient populations due to the complex interplay of symptoms of emotional distress with the symptoms of serious illness. It is challenging to navigate the diagnostic spectrum of grief, persistent complex bereavement disorder, demoralization, adjustment disorder with depressive features, and major depressive disorder.
Today, people are living longer with heart disease while its prevalence is increasing. Historical trends that have limited the integration of palliative care in cardiology and HF care are shifting. Over the last 10 years, there has been growing evidence to support palliative care interventions for HF pat ients and their families, as well as integrating interdisciplinary HF, palliative care, and hospice. Patients with HF require complex pharmacological and self-care regimens to control symptoms and prevent recurrent hospitalizations.