National Consensus Project and Clinical Practice Guidelines Kelli Gershon, MSN, APRN, BC-PCM...
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National Consensus Project and Clinical Practice
GuidelinesKelli Gershon, MSN, APRN, BC-PCM
Palliative Care
The University of Texas M.D.Anderson Cancer Center
What is the National Consensus Project?
Consortium of three key national palliative care organizations:
American Academy of Hospice and Palliative Medicine
Hospice and Palliative Nurses Association National Hospice and Palliative Care
Organization
National Consensus Project Mission
To create a set of voluntary clinical practice guidelines to guide the growth and expansion of palliative care in the United States
National Consensus Project Structure
Steering Committee – 20 members develop draft document
Advisory Committee – 100 nationally recognized leaders across a variety of health care settings, review and revise
Liaison Organizations – 50 organizations with major responsibility for health care of patients with life-threatening illnesses, endorse and disseminate the standards
Core Elements of Palliative Care
Patient Population Patient and Family Centered Care Timing of Palliative Care Comprehensive Care Interdisciplinary Team Attention to Relief and Suffering
Core Elements of Palliative Care
Communication Skills Skill in Care of the Dying and Bereaved Continuity of Care Across the Settings Equitable Access Addressing Regulatory Barriers Quality Improvement
Clinical Practice Guidelines
Consensus of the leading palliative care organizations in the U.S., based on
1. Scientific evidence
2. Clinical experience
3. Expert opinion
Baseline Assumptions
Goal Guidelines Healthcare quality standards Codes of ethics Ongoing revision Peer-defined guidelines Specialty care Continuing professional education Applicability of guidelines
Clinical Practice Guidelines: 8 Domains
1. Structure and Process of Care2. Physical3. Psychological and Psychiatric4. Social5. Spiritual, Religious and Existential6. Cultural7. The Imminently Dying Patient8. Ethics and Law
Domain 1: Structure and Processes of Care
Comprehensive interdisciplinary (ID) assessment of patient and family
Care plan based on values, goals and needs of patient and family
Interdisciplinary team (IDT) provides services based on care plan
IDT may include trained and supervised volunteers
Domain 1: Structure and Processes of Care
Support for education and training is available to the IDT
Palliative care program (PCP) committed to quality improvement in clinical and management practices
PCP recognizes emotional impact on the palliative care team of providing care to patients with life threatening illness and their families
Domain 1: Structure and Processes of Care
PCP should have relationship with one or more hospices and other community resources in order to provide continuity of the highest quality palliative care across the illness trajectory
Physical environment should meet preferences, needs and circumstances of the patient and families
Domain 2: Physical Aspect of Care
Pain and other symptoms and side effects are managed based upon the best available evidence
Domain 3: Psychological and Psychiatric Aspects of Care
Psychological and psychiatric issues are assessed and managed based on best available evidence
A grief and bereavement program is available to patients and families
Domain 4: Social Aspects of Care
Comprehensive ID assessment identifies social needs of patients and their families, and care plan developed in order to respond to these needs
Domain 5: Spiritual, Religious, and Existential Aspects of Care
Spiritual and existential dimensions are assessed and responded to based upon the best available evidence
Domain 6: Cultural Aspects of Care
PCP assess and attempts to meet the culture-specific needs of patients and families
Domain 7: Care of the Imminently Dying Patient
Signs and symptoms of impending death are recognized and communicated, and care appropriate for this phase of illness is provided to patient and family
Domain 8: Ethical and Legal Aspects of Care
The patient’s goal, preferences and choices are respected within the limits of applicable state and federal law and form the basis for the plan of care
PCP is aware of and addresses complex ethical issues arising in the care of persons with life-threatening debilitating illness
Domain 8: Ethical and Legal Aspects of Care
The PCP is knowledgeable about legal and regulatory aspects of palliative care
National Consensus Project and Clinical Practice
GuidelinesFor more information:
www.nationalconsensusproject.org