SECTION 2
Client Care and Service
Community Focused
Continuing Care
Emergency/Trauma
Maternal, Child & Youth
Medical Care
Mental Health
Palliative Care
Specialized Intensive Care
Surgical Care

SECTION 3
Support Services
Information Management
Human Resources
Physical Environment

SECTION 4
Leadership/Partnership
Strategic Directions
Implementing Strategic Directions

Palliative Care

This long standing team has developed a good clinical program that incorporates a quality management culture. The strong links and respect between care givers are very evident in the team functioning. Since this program deals with the different stages of dying, it is suggested that there is an opportunity to offer services to clients who are in transition but not yet part of the program, for example, clients of residential facilities.

Close referral networks are established in all areas of the region, with informal links to Vancouver mainland. Strong relationships have been developed between all care givers in this program and the central out-patient registry. Effort is made to share education and communication for developing and maintaining required skill sets thus, consistency in quality of care is assured. This is enhanced by having a single standard of care for palliative clients.

Orientation and information processes are excellent. These include numerous pamphlets and guidelines, a resource library maintained by a volunteer group, and partnering with client and family to foster respective roles and responsibilities. Part of the program entrance criteria includes an informed consent process.

Documentation is comprehensive, multidisciplinary and ongoing, with regular review of care plans. Commendation is given for the broad collaboration of physicians, nurses, therapists, pastors as well as others. This reflects a consultative model of care. Continuity of nursing care is emphasized. There is good community collaboration as well through advisory and volunteer groups. Client and family involvement is built into all stages of care.

Education and counseling are offered from initial contact to the bereavement period. Some clients may experience a lack of spiritual support if they were not receiving this previously in the community. It is anticipated that the recently hired spiritual coordinator will close this gap. In addition to the attention paid to supporting client and family, there is support for the staff and volunteers as well.

Clinical practice guidelines are used and evidence based care is reviewed. The standard on cancer symptom control is currently being validated at the local level. Regionalization is cited as having strengthened links to services such as neurology, oncology and pain management specialists. It has also facilitated a smoother transition from acute to long term or home care support.

Recognition is given for the action and resolution of issues identified through quality monitoring and improvement. Support is given to the plan to move beyond the program and look at intake and post death stages. The quality maintenance and management environment extends into the community. A good example relates to how the team supports clients and their families at the time of imminent death. Previously identified as a risk, indicators were used to monitor continuity and gaps in support. The results were measured, changes were made and since November, 1999 a target of 100 per cent support has been maintained. It is suggested that this approach be repeated for new users of the program.

Team members represent the various disciplines across the care continuum and demonstrate an integrated and co-ordinated approach. Participation by an intensive care physician would benefit team work and should be pursued.

Client profiles have been completed and clients come from within and outside the region. Admission and discharge criteria are in place for both critical and intensive care units. Communication with referral centres is excellent. Good information is received at time of client transfer. There is good access to a regional ethics committee for issues associated with referrals. The limiting factor in the referral process is the current number of ventilated beds available.

Pre-printed orders and time lines promote consistency. 24-hour visiting supports clients throughout their stay in the unit, as does the 24-hour pastoral care service. Every effort is made to provide comfort measures such as reassuring clients that they are in control. There is ongoing support for clients and families which is augmented by education, and information pamphlets. Social issues are referred to pastoral/spiritual care and social workers.

There is extensive collaboration around care planning and review. Informed consent is usually obtained while the client is in the emergency department and is an ongoing process depending on client condition. There is provision for substitute consent. Processes are in place and audited to ensure that consents are always signed.

Interdisciplinary documentation is being promoted through the move to automated charting. Allergies are noted on the chart, flagged in the computer and also identified on clients’ arm band. Interdisciplinary assessments and planning occur through daily informal rounds and weekly formal rounds. These rounds also assist in identifying any ethical considerations which are referred to the ethics committee. Family members, and clients to the extent possible, have input to care and time lines and are encouraged to become involved throughout the process.

Evidence based care is practiced and effort is made to stay abreast of advances in protocols, technology and drugs. Clients are screened for MRSA upon admission, while on the unit and again at discharge. There is good participation in research and clinical drug trials. Recognition is given for participating in an ongoing study of congestive heart failure. Also recognized are the opportunities for cross training of staff in the emergency, intensive and critical care areas. The interdisciplinary neuro-rehabilitation team is recognized for the seamless transition for clients from emergency to acute to community care.

There is a part-time program evaluation position in place. While it is difficult to get precise evaluation data, the “measuring up survey” that recognized excellence in cardiac care is an indication of the quality of the program. An evaluation of the cardiac rehabilitation follow-up program has also been done and identified an opportunity to improve in the area of lifestyle changes such as smoking. Discussions with the ministry of health are under way to establish a community renal dialysis program.

The team has identified its priorities for improvement. These relate to use of sedation and analgesic for ventilated clients, early ambulation of clients, and telemetry monitoring. Indicators are used and recognition is given for monitoring time line variances, and drug use trends. Improvement initiatives undertaken relate to the process for accessing beds, and doing cardio versions in the catheterization laboratory every Friday.